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Chronic hyperglycemia initiates a cascade of molecular events—including the accumulation of advanced glycation end products (AGEs), activation of the polyol pathway, enhanced protein kinase C (PKC) signaling, and mitochondrial dysfunction—culminating in glomerular hyperfiltration, podocyte injury, and progressive glomerular and tubulointerstitial fibrosis

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Schumann K, Borch-Iohnsen B, Hentze MW, Marx JJ