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How this occurs is unknown, but researchers believe it is a result of proteins secreted by skin cells that the body forms an antibody to, leading to an immune attack

H.Cadenas-PliegoG.Ortega-OrtizH.Gonzlez-MoralesS.Benavides-MendozaA.Valds-ReynaJ.et al (2020)

IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

Thus, if a patient were in Stage 3a based on their GFR, but had normal excretion of protein in their urine and no other indications of kidney disease, that would warrant continued monitoring of that patient for changes, but not necessarily aggressive therapy for CKD [24]