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A possible vicious cycle between damaged tubules and hypoxia in CKD progression. Hypoxia, mainly due to loss of peritubular capillaries, prevents damaged tubules from recovery. Decreased VEGF expression in these tubules mediates capillary rarefaction and hypoxia through impaired angiogenesis. Thus, damaged tubules with decreased VEGF and hypoxia due to capillary rarefaction can form a vicious cycle.
