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We evaluated the articles for certainty of evidence using a modified GRADE tool and robustness of the associations by comparing Mendelian randomisation (MR) sensitivity analyses

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Under high glucose conditions, Rho A is activated, leading to elevated intracellular oxidative stress, increased release of inflammatory cytokines (e.g., TNF-α and IL-1β) from renal tubular epithelial cells, and changes in the expression of fibronectin, CTGF, TGF-β1, collagen type IV, and E-calcineurin, which regulate calponin-mediated cell-cell adhesion, as well as increased pro-fibrotic growth factor, and expression of extracellular matrix components and extracellular matrix components