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In cases where results are borderline, additional tests such as holotranscobalamin (active B12), methylmalonic acid or homocysteine may be requested to clarify B12 status

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Biological pathways such as activated transforming growth factor- (TGF) signaling, Notch signaling, Wnt signaling, and Hedgehog signaling disrupt central metabolism and drive mesenchymal metabolic shifts in diabetic kidneys, ultimately leading to deposition of collagens, extracellular matrix proteins, fibronectin, vimentin, and N-cadherin in interstitial spaces (Huang and Susztak, 2016

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