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Correspondence |

Relationship Between Pulmonary Emphysema and Renal Function in SmokersPulmonary Emphysema and Renal Function in Smokers FREE TO VIEW

Elizabeth N. Pavlisko, MD; Victor L. Roggli, MD, FCCP; Thomas A. Sporn, MD; Tim D. Oury, MD, PhD
Author and Funding Information

From the Department of Pathology (Drs Pavlisko, Roggli, and Sporn), Duke University Medical Center; and the Department of Pathology (Dr Oury), University of Pittsburgh Medical Center.

Correspondence to: Elizabeth N. Pavlisko, MD, Duke University Medical Center, Room 201M, Davison Bldg, 201 Trent Dr, Box 3712 DUMC, Durham, NC 27710; e-mail: elizabeth.pavlisko@duke.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1516-1517. doi:10.1378/chest.13-0125
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To the Editor:

We read with interest the article by Chandra et al1 in CHEST (September 2012). These authors reported that in smokers, more severe emphysema is associated with kidney dysfunction independent of the common risk factors for kidney disease. They further noted that no prior study has investigated the relationship between kidney function and emphysema and that the mechanisms of kidney dysfunction in patients with emphysema need further investigation.

Chandra and colleagues1 studied 508 cases, assessing the severity of emphysema by CT scan and comparing the results with glomerular filtration rates. However, we note that from Figure 3 of their publication, only 16 patients had an emphysema percentage of ≥20%. In this regard, we would like to call to the attention of the authors and the readership of CHEST a study published in 1988 that one of us (V. L. R.) participated in.

Pratt et al2 examined the cause of death in a consecutive series of 1,033 autopsies and observed that chronic renal disease is a much less common cause of death in people with emphysema, as compared with those without emphysema (P = .0003). The trend persisted when individuals who died of smoking-related diseases were eliminated from the analysis (P < .0003). When only those cases with discernible emphysema were examined (n =272), the percentage of emphysema in patients dying of chronic renal disease was significantly lower than in all other causes of death (P < .006). The percentage of emphysema was assessed by point counting of inflation fixed lung specimens to determine the volume percentage of emphysema.3

From a mechanistic perspective, Pratt et al2 proposed that destruction of the pulmonary vascular bed in emphysema reduces the efficiency of conversion of angiotensin I to angiotensin II. This, in turn, could interrupt, or at least ameliorate, the vicious cycle of renal injury and release of renin leading to production of angiotensin, with a resulting increase in BP and further renal injury. Thus, an individual with emphysema might be less likely to progress to fatal end-stage renal disease. These observations are also consistent with epidemiologic studies that have shown that smokers have, on average, a lower BP than that of nonsmokers.4 We are in complete agreement with Chandra et al1 that further studies are necessary to understand the relationship between emphysema and renal function and to explain further the discrepant findings in these authors’ study as compared with those of Pratt et al.2

References

Chandra D, Stamm JA, Palevsky PM, et al. The relationship between pulmonary emphysema and kidney function in smokers. Chest. 2012;142(3):655-662. [CrossRef] [PubMed]
 
Pratt PC, Roggli VL, Tesoriero VJ. Lower incidence of death from chronic renal disease in patients with nonlethal emphysema: a statistical study. Mod Pathol. 1988;1(1):57-63. [PubMed]
 
Weibel ER. Morphometry of the Human Lung. New York, NY: Academic Press; 1963.
 
Green MS, Jucha E, Luz Y. Blood pressure in smokers and nonsmokers: epidemiologic findings. Am Heart J. 1986;111(5):932-940. [CrossRef] [PubMed]
 

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References

Chandra D, Stamm JA, Palevsky PM, et al. The relationship between pulmonary emphysema and kidney function in smokers. Chest. 2012;142(3):655-662. [CrossRef] [PubMed]
 
Pratt PC, Roggli VL, Tesoriero VJ. Lower incidence of death from chronic renal disease in patients with nonlethal emphysema: a statistical study. Mod Pathol. 1988;1(1):57-63. [PubMed]
 
Weibel ER. Morphometry of the Human Lung. New York, NY: Academic Press; 1963.
 
Green MS, Jucha E, Luz Y. Blood pressure in smokers and nonsmokers: epidemiologic findings. Am Heart J. 1986;111(5):932-940. [CrossRef] [PubMed]
 
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