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Under these circumstances cortical hypoxia is overt, leading to activation of the renin-angiotensin-aldosterone system, loss of kidney function, rarefaction of small renal vessels, kidney fibrosis, atrophy, and end stage kidney disease designated ischemic nephropathy
For the cyanocobalamin component, while generally considered safe with few absolute contraindications, certain conditions warrant caution

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For example, other studies show similar effects on: plasma measurement of DNA [40, 41], thiols [42], and creatinine [43]
[DOI] [PubMed] [Google Scholar] 130.Kaur K, Narang RK, Singh S