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doi:10.1001/jama.2024.10816 Fredrick TW, Camilleri M, Acosta A

Biological pathways such as activated transforming growth factor- (TGF) signaling, Notch signaling, Wnt signaling, and Hedgehog signaling disrupt central metabolism and drive mesenchymal metabolic shifts in diabetic kidneys, ultimately leading to deposition of collagens, extracellular matrix proteins, fibronectin, vimentin, and N-cadherin in interstitial spaces (Huang and Susztak, 2016