Diabetic nephropathy can occur in about 20-40% of diabetic patients, and diabetic nephropathy is one of the important causes of end-stage renal failure. As the incidence of diabetic nephropathy in China increases year by year, more and more patients enter end-stage renal failure and need long-term hemodialysis or kidney transplantation, which brings heavy social and economic burden. Therefore, early prevention and treatment of diabetic nephropathy is of great importance. The most important phenomenon of early diabetic nephropathy is the slightly higher than normal urinary albumin excretion, called microalbuminuria, which is 20-200μg/min or 30-300mg/24h or urinary albumin/creatinine (ACR) 30-300mg/g. Once clinical proteinuria (urinary protein >0.5g/24h) occurs, glomerular function is progressively and irreversibly The glomerular function is progressively and irreversibly declining. Diabetic nephropathy has no manifestations in its early stages. The diagnosis may be confirmed in three ways. One way is through medical checkups, or by your own commercial insurance, at the relevant medical checkup facility. The urine can be checked and proteinuria can be found. The second way is that the endocrinologist routinely checks the urine and finds it. The third way is to see a doctor after the patient has developed symptoms, which is often very late, to the fourth stage of diabetic nephropathy or later. It is recommended that diabetic patients should focus on prevention and regular urine examination for early detection. How to diagnose diabetic nephropathy? It is sometimes difficult to determine whether proteinuria is caused by kidney disease or other diseases. Now there are some clinical practice guidelines for doctors, and doctors usually follow these guidelines to determine this patient. The first one is microproteinuria plus fundus lesions. Microprotein means that the total amount of urine protein is less than 0.3 grams per day or less than 200 micrograms of protein per minute, which is called microprotein. If the microprotein is accompanied by fundus lesions, the clinical diagnosis of diabetic nephropathy can be made, this is one. The second article, the clinical diabetic patients whose daily urine protein has exceeded 0, 3 grams, basically can determine diabetic nephropathy. Sometimes we look at the urine test inside the urine protein a plus or two plus, this is only qualitative, is not very reliable, must do 24-hour urine protein quantification. The daily urine protein exceeds 0 or 3 grams, which is called clinically significant proteinuria, and diabetic patients with significant proteinuria can generally be identified as diabetic nephropathy. The following two conditions are not diabetic nephropathy. First, if there is proteinuria, whether it is microscopic or massive, or it is called clinically significant, and at the same time there is hematuria, it is generally not diabetic nephropathy. This hematuria has a plus sign, and it is not accurate. If there is a plus sign on the first urine test strip, there may not be a plus sign on the next day when you check again. You have to do a microscopic examination of urine sediment in patients with hematuria with a plus sign to determine whether there is hematuria or not. In addition, if the patient’s kidney function is all bad, none of them have proteinuria, such patients have diabetes though, and this nephropathy is not diabetic nephropathy. But when doctors face patients, the patient’s condition may not fall on this one or that one, the clinical situation is very complex and needs to be combined with multiple information to make a comprehensive judgment. Diabetic nephropathy can be divided into five stages. The first stage is the glomerular hyperfiltration stage. Hyperfiltration looks like a good sign of kidney function, but in fact, hyperfiltration is a sign of kidney overload, which will accelerate the speed of entering the second stage, which is not a good thing. Good glycemic control and weight control section alleviate hyperfiltration. In the second stage, hyperfiltration can still be manifested, and some patients can lose hyperfiltration and have reversible microalbuminuria during exercise. From the third stage, albuminuria starts to appear, and it is microalbuminuria at first. In this stage, if the blood sugar, blood pressure, lipid, diet and weight are well controlled, microalbuminuria can disappear in some patients. With the development of diabetic nephropathy, the kidney lesions become more and more serious, the albuminuria gradually increases and enters the fourth stage of diabetic nephropathy, which is manifested as clinical albuminuria, that is, albuminuria that can be detected by conventional methods. Once it enters the fourth stage, diabetic nephropathy is irreversible, and albuminuria can be reduced by various means, but it is impossible for albuminuria to disappear. Most patients develop hypertension and the glomerular filtration rate begins to decline. Diabetic nephropathy continues to progress, and a decline in kidney function occurs, which eventually leads to kidney failure. Diabetic lesions are in a continuous progressive process, which can be slowed down with appropriate intervention. By the fifth stage is end-stage renal failure, characterized by widespread glomerular capillary occlusion with glomerular vitelliform degeneration, glomerular filtration rate has become very low, nitrogen retention, significant hypertension, and the need for renal replacement therapy (hemodialysis, peritoneal dialysis or renal transplantation). Not every diabetic patient will go through the above 5 stages, instead there are most patients who only stay in the beginning two stages and still have no significant kidney damage after 20-30 years of disease. However, once the disease progresses to the third stage, microalbuminuria, it is likely to continue to progress to the fourth stage and develop the typical manifestations of diabetic nephropathy. Treatment should try to make the disease stay in the third stage, once it reaches the fourth stage, the course of the disease is irreversible, and most patients will enter end-stage renal failure. Therefore, diabetic nephropathy, as much as possible, early detection, early prevention, early treatment, do not wait until a very serious time to pay attention to. Diabetic nephropathy is not yet a special treatment. The principles of treatment are: 1. Strict control of blood sugar, before the emergence of clinical diabetic nephropathy, that is, in the early stages of diabetes, strict control of diabetes with insulin pumps or multiple subcutaneous injections of insulin, so that blood sugar remains basically normal, can delay or even prevent the occurrence and development of diabetic nephropathy, reduce the increased glomerular filtration rate and improve microalbuminuria, which is also beneficial to other complications. After the appearance of clinical diabetic nephropathy glucose-lowering drugs should generally be changed to insulin. 2, control hypertension, hypertension will promote the development of renal failure, effective antihypertensive treatment can slow down the rate of decline in glomerular filtration rate and reduce the amount of urinary albumin excretion. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists can be the drug of choice, often in combination with other antihypertensive drugs, such as calcium antagonists, diuretics, beta-blockers, etc. Blood pressure in diabetic patients with blood pressure ≥ 130/80 mmHg should be treated with antihypertensive drugs and should be controlled below 130/80 mmHg. For patients with urine protein quantification greater than 1 g/24 h, blood pressure should be controlled at 125/75 mmHg. Antihypertensive therapy is also beneficial for retinopathy in diabetes. However, in elderly patients with renal insufficiency or high blood creatinine, angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (e.g., lortensin, cloxacin, dyvin, amboval, etc.) should be used with caution, especially to guard against the occurrence of hyperkalemia; 3. Limiting protein intake and appropriately reducing the amount of protein in the diet (0,8/kg?d) can reduce intra-glomerular pressure, alleviate hyperfiltration and reduce urinary protein. On the contrary, a high protein diet can aggravate renal function damage. Those who have already developed renal insufficiency should limit protein intake and consume protein with high essential amino acids. 4, dialysis treatment and kidney transplantation, once renal failure occurs, dialysis treatment and kidney transplantation are effective methods. Here I will introduce a typical case of diabetic nephropathy in our department which has achieved good results: the patient, female, 63 years old, found to be diabetic for 12 years, started to have swelling and proteinuria one year ago, and was diagnosed as “diabetic nephropathy” by kidney puncture pathology, treated with antihypertensive, diuretic and blood sugar control. The patient had been hospitalized in our nephrology department for several times with recurrent edema, the last time in January 2013, when he was hospitalized in our department. The diagnosis of diabetic nephropathy was met. After admission, the patient was treated with diuretic, blood pressure control and blood glucose control, while anticoagulation, blood stasis activation and microcirculation improvement were given to improve the patient’s blood albumin, swelling and shortness of breath, and the patient was discharged. The patient has been discharged for more than 2 months, and his condition is stable and he has not come back to hospital. Our experience is that for patients who enter the fourth stage of diabetic nephropathy, at this time the patient has a large amount of proteinuria and high swelling, and even complications of cardiac failure, it is necessary to take a combination of Chinese and Western medicine comprehensive treatment measures, in addition to diuresis, control of blood pressure and blood glucose, should also take measures such as anticoagulation, blood activation, improve systemic microcirculation, which is conducive to alleviate the disease. At the same time, we should actively provide necessary publicity and education to patients with diabetic nephropathy, such as telling them to pay attention to diet control, eat less and more meals, avoid excessive water intake, and go to the hospital as soon as possible if they have symptoms of swelling and shortness of breath.