VWF and endothelial dysfunction: Some research has indicated that the increased kidney endothelial permeability associated with microalbuminuria may be a sign of diffuse endothelial dysfunction, leading to cardiovascular damage and elevated risk of death.27,28 The UACR within the normal range or microalbuminuria may also induce alterations in von Willebrand factor, fibrinogen, and thrombomodulin.29,30,31 More investigation into the biological mechanisms of UACR and CVH associated with mortality are needed from population-based and animal studies.