MA has been linked to increases in tissue aldosterone, endothelin, and angiotensin II levels, mediators which have been proved to lead to CKD progression.[47,48] Furthermore, increased ammonium production due to MAC is associated with local complement activation and increased tubulointerstitial fibrosis.[49] Several observational studies have indicated that lower serum bicarbonate levels are associated with CKD progression and increased incidence of ESRD.[9,50–52] Accordingly, in our population patients with MA were in more advanced CKD stages. Here, AGT is linked to chronic kidney disease.