TGFB1 and diabetic kidney disease: The combined effect of triple therapy, further activating the intrarenal non-classical RAS above the impact of ramipril, is a key observation regarding mechanisms of add-on tissue protection by the combined therapy (Figure 7) that affects subsequent proinflammatory or profibrotic pathways such as TGF-β1, NF-κB, or oxidative stress involved in diabetic nephropathy progression.