Our IVW-MR analyses extend the causal implications of cathepsins to DN, revealing novel associations with Cathepsin H. As a microvascular complication affecting ~ 40% of diabetics and the leading global cause of end-stage kidney disease (ESKD) [42], DN pathogenesis may involve Cathepsin H-mediated pathways, given its renal expression in podocytes and proximal tubules [43]. Here, CTSS is linked to diabetes mellitus.