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Macrophage recruitment and activation in DN. Hyperglycemia induces increased expression of cell adhesion molecules (ICAM-1/VCAM-1) and chemokines (MCP-1/CSF-1), thereby enhancing the recruitment of monocytes to the kidney. Chemokines also promote transendothelial migration. Monocytes mature into macrophages and subsequently release inflammatory cytokines, leading to the progression of DN.
