NPPA and diabetes mellitus: In contrast to pregnancy, diabetes leads to greater vasoconstriction of the efferent arteriole compared with the afferent arteriole, effectively causing GHF but also glomerular hypertension and an increase in the filtration fraction.43 Although the exact mechanisms remain uncertain, a multitude of mediators have been implicated, such as insulin-like growth factor 1, atrial natriuretic peptide, increased glucose and sodium retention, sorbitol, and advanced glycation products.44,45,46,47