REN and endothelial dysfunction: Albuminuria is theoretically related to multiple pathophysiological processes including comorbidities, systemic inflammation, and endothelial dysfunction and is a marker of generalized cardiovascular damage.26, 27 Other possible factors could be overactivity of the renin–aldosterone system and sympathetic tone and alteration in mineral metabolism such as 1,25-hydroxyvitamin D, parathyroid hormone, and fibroblast growth factor 23,28, 29, 30 all of which are associated with progressive kidney dysfunction and contribute to the development and worsening of cardiac damage.