Many laypeople believe alcohol is harmful to the kidneys. I am not sure how this notion arose, unless it is a result of confusing the liver with the kidneys. It is true that alcohol causes an increase in urine flow, but this does no harm to the kidneys, at least when moderate amounts of alcohol are ingested. It may cause some degree of dehydration— one component of a hangover.

As far as I know, there is no direct evidence for any adverse effect of moderate alcohol intake on the kidneys, other than indirectly through the occurrence of metabolic disorders such as potassium or magnesium deficiency or metabolic acidosis.

However, a recent epidemiological study, conducted by telephone, has shown that people who by their own accounts consume more than two drinks per day are more likely to have end-stage renal disease than people who drink less. The authors of the study controlled for differences in age, race, sex, income, use of opiates, cigarette smoking, history of diabetes, and consumption of moonshine (home-distilled whiskey). This association suggests, but does not prove, that heavy alcohol intake harms the kidneys. A lower intake of alcohol did not appear to be harmful. As the study's authors note, "Because these results are based on self-reports in a case-control study, they should be seen as preliminary." No studies have compared the relative dangers to the kidneys of beer, wine, and hard liquor.

Alcoholic drinks generally contain no protein and therefore could be viewed as a useful source of calories on a low-protein diet. If excess intake is not a problem, alcohol is a desirable component of a low-protein diet.

Abundant evidence has been published establishing that smoking hastens the progression of kidney disease, especially in men. In patients with high blood pressure or with diabetes who do not yet show signs of renal disease, smoking increases the likelihood of abnormal urinary protein excretion, a precursor of renal failure. In a type of connective tissue disease called lupus, which commonly damages the kidneys, smokers progress to the end stage twice as fast as nonsmokers. When healthy nondiabetic individuals with normal blood pressure are screened by measurement of serum creatinine level and urinary protein, abnormally elevated levels of both are found more commonly in men (but not women) who are long-term smokers, according to a recent Australian study. These observations suggest that smoking may cause kidney damage.

As a patient with kidney disease, it is imperative that you take steps to cut smoking out of your life. In addition to nicotine patches and gum, many good programs can help. Call the American Lung Association for more information on quitting smoking, and find out about local programs in your community Local hospitals may offer similar programs.

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