Smoking causes kidney deterioration in diabetic patients with adverse effects on four different aspects of albumin excretion: It increases the risk of microalbuminuria[5], shortens the time interval between onset of diabetes and onset of albuminuria or proteinuria [6,7], accelerates the rate of progression from microalbuminuria to persistent proteinuria [22,23], and accelerates the rate of progression of diabetic nephropathy to ESRD [6,8]. This evidence concerns the gene ALB and diabetic kidney disease.