Fifth, ketosis‐prone T2DM had a significantly higher rate of abnormally elevated proteinuria, which was consistent with the findings of Zuo et al.22It has been shown that β‐hydroxybutyric acid can cause a significant increase in waveform protein expression and a significant decrease in E‐calmodulin levels or cause some degree of kidney damage by regulating the epithelial‐mesenchymal transition of renal tubular epithelial cells via the transforming growth factor‐beta/Smad3 signaling pathway.23, 24, 25. This evidence concerns the gene SMAD3 and Nephropathy.