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Herein, we describe the case of a 66-year-old woman with CKD who underwent a protocol KPMP kidney biopsy. Her clinical history included well-controlled diabetes mellitus, hypertension, and proteinuria. The patient\u2019s histopathology was consistent with modest hypertension-related kidney injury, without overt diabetic kidney disease. Transcriptomic signatures of the glomerulus, interstitium, and tubular subsegments were obtained from laser microdissected tissue. The molecular signatures that were uncovered revealed evidence of early diabetic kidney disease adaptation and ongoing active tubular injury with enriched pathways related to mesangial cell hypertrophy, glycosaminoglycan biosynthesis, and apoptosis. Molecular evidence of diabetic kidney disease was found across the nephron. Novel molecular assays can supplement and enrich the histopathologic diagnosis obtained from a kidney biopsy.<\/jats:p>","DOI":"10.2215\/cjn.10350721","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T14:25:18Z","timestamp":1639578318000},"page":"594-601","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Molecular Signatures of Diabetic Kidney Disease Hiding in a Patient with Hypertension-Related Kidney Disease"],"prefix":"10.2215","volume":"17","author":[{"given":"Jiten","family":"Patel","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Texas Southwestern, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose R.","family":"Torrealba","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Southwestern, Dallas, 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