MMP9 and hypertrophy: Consequently, metabolic factors such as ROS and AGEs, gut microbiome changes, inflammatory factors like TNF-α, IL-1,IL-6, IL16, IL-18, MCP-1, and matrix metalloproteinase-9 (MMP-9), fibrotic factors including transforming growth factor beta (TGF-β), fibronectin, collagen-1, connective tissue growth factor (CTGF), and hemodynamic factors like endothelin and renin-angiotensin-aldosterone system (RAAS) induce albuminuria and reduce renal function by causing glomerular hypertrophy, mesangial expansion, and tubulointerstitial inflammation22.