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The various mechanisms by which smoking exerts its adverse effects on renal function and exacerbate renal impairment are: - Increased blood pressure - Reduction of renal perfusion - Increased production of various hormones that accelerate renal damage In addition, smoking causes chronic kidney damage since: - It narrows the blood vessels that bleed the kidneys as well as the small vessels in the kidneys - Tobacco contains over 3000 to 4000 particles and gases, many of which are nephrotoxic on their own - There are heavy metals in tobacco smoke - The oxidative stress created directly causes kidney damage - It reduces glomerular filtration rate over time Is smoking related to the onset of CKD or its aggravation