Diabetes mellitus is the first cause of chronic kidney failure in western developed countries, and in recent years it has also shown a dramatic increase in China. With the rapid development of China’s economy, on the one hand, people’s diet structure has changed greatly, often taking too much food causing excess energy, on the other hand, the increasing level of automation in society, work and physical loss in life has reduced, diabetes has become an epidemic and multi-morbidity in China, and consequently the kidney damage caused by diabetes is becoming more and more prominent, diabetic nephropathy has quietly replaced glomerulonephritis, becoming the Diabetic nephropathy has quietly replaced glomerulonephritis as the number one killer of kidney health. The prevention and treatment of diabetic nephropathy has become an issue of widespread concern for medical professionals and the whole society. Diabetic patients can develop a variety of urological manifestations, such as diabetic glomerulosclerosis, renal atherosclerosis, small renal artery sclerosis, necrotizing papillitis, contrast nephropathy, bladder dyssystole, neurogenic bladder, urinary tract infection, and uric acid nephropathy in combination with hyperuricemia. Diabetic glomerulosclerosis is a specific renal complication of diabetes related to abnormal glucose metabolism, called diabetic nephropathy. Diabetic nephropathy mainly manifests as proteinuria and renal function impairment, and is clinically divided into five stages. In the first stage, there is no obvious renal damage, no proteinuria in urine examination, just some pathological changes; in the second stage, intermittent microproteinuria appears, and intermittent albumin increase can be found in urine examination; in the third stage, persistent microproteinuria, and persistent albumin increase can be found in urine examination; in the fourth stage, obvious renal manifestations, beginning with increased urinary foam, the appearance of mild swelling, increased nocturia, gradually appearing oliguria, hypertension, massive proteinuria, hypoproteinemia, severe swelling, hyperlipidemia, the appearance of chest and ascites; the fifth stage of renal failure, the appearance of anemia, anuria, increased serum creatinine, urea nitrogen. Diabetic nephropathy is difficult to reverse when it develops to a certain degree, with serious harm and lack of effective methods. Not all diabetic patients with proteinuria, nephrotic syndrome, renal failure and other changes are diabetic nephropathy. Diabetic nephropathy is usually diagnosed clinically based on a patient’s history of diabetes for more than 5 years and proteinuria. A recent study showed that this diagnostic idea often delays the diagnosis and treatment of patients. 233 cases of diabetes combined with proteinuria accounted for only 27.5% of simple diabetic nephropathy, 53.2% were non-diabetic nephropathy, and 19.3% had both of these conditions. In the early stage of diabetic nephropathy, there are only diabetic manifestations such as excessive drinking, irritable thirst, weight loss, etc. There are no obvious manifestations of nephropathy and normal urine routine examination, so only 24-hour urine microalbumin measurement can be performed regularly. Diabetic nephropathy detected early can be reversed with early active treatment. It is generally recommended that type 1 and type 2 diabetic patients should be examined at least once a year. The core of treatment for non-insulin-dependent diabetic nephropathy is to control blood glucose and improve the body’s resistance to insulin so that fasting blood glucose is kept below 6.5 mmol/L and glycated hemoglobin is controlled at about 6.5%. It must be emphasized that not the lower the blood sugar control the better, the danger of hypoglycemia is significantly more than the danger of slightly increased blood sugar, diabetes control elderly patients should be relaxed to 7.0 mmol/liter, glycosylated hemoglobin 7%. Diet therapy has been the key to diabetic nephropathy since the beginning. In the early stage of diabetic nephropathy, a strict diabetic diet is needed, through regular and quantitative diet, restriction of caloric intake, increased exercise, weight control, and restriction of glucose-containing foods, which is very effective in controlling the disease; when hypertension and swelling appear, a low-salt or salt-free diet should be started; when combined with hyperlipidemia, a low-fat diet should be implemented, and the consumption of animal offal and fat should be restricted; for hyperuricemia, a low purine diet should also be implemented. In case of hyperuricemia, a low purine diet should be implemented, with restrictions on broth, meat and shellfish; in case of chronic renal failure, a uremic diet should be implemented, with high quality animal protein and appropriate restrictions on vegetable protein. Reasonable choice of hypoglycemic drugs is very necessary. When blood sugar cannot be controlled after diabetic diet and exercise therapy, oral hypoglycemic drugs or insulin injection should be considered. In the early stage, you can choose glucose-lowering drugs that have no effect on kidney function, such as rosiglitazone or pioglitazone, which increase insulin sensitivity, and choose glucose-lowering drugs that are rarely excreted through the kidneys, such as glycopeptide, acarbose, voglibose, selegiline, sagliptin, etc.; when there is obvious proteinuria or kidney function impairment, insulin should be injected early, and wearing insulin pump can achieve better results. Hypertension is a common comorbidity of diabetic nephropathy and a major factor in the development and deterioration of diabetic nephropathy, antihypertensive drugs that do not affect renal function should be selected. Diuretics (e.g., tachyphylaxis and spironolactone) should be used for severe swelling, and most antihypertensive drugs also have the effect of reducing urinary protein. Angiotensin receptor blockers and angiotensin-converting enzyme inhibitors are preferred for controlling urinary protein, and their doses are much larger than those for lowering blood pressure, and their doses should be limited to those that do not cause discomfort to the patient, in addition, aldosterone receptor inhibitors (such as spironolactone), betablockers, and herbal medicines for dispelling wind are also available. Disorders of lipid metabolism are important factors that seriously affect the prognosis of patients, and hyperlipidemia and hypercholesterolemia should be corrected by various methods. Statins such as simvastatin and fluvastatin are usually recommended in patients with normal liver function; ginkgo preparations and red tonic preparations can be used in those with abnormal liver function. When diabetic nephropathy develops to an advanced stage with severe oliguria or anuria, the kidneys are unable to excrete the toxic substances metabolized by the body, in which case, the only way to maintain normal excretion of toxic substances in the body is through renal replacement therapy (dialysis or kidney transplantation). Renal replacement therapy for diabetic nephropathy should be considered for blood purification earlier than glomerulonephritis uremia, when the blood creatinine is at 480 micromol/liter. At present, the development of diabetic nephropathy is considered irreversible. Theoretically, diabetic nephropathy cannot be cured after the manifestation of nephrotic syndrome, and proteinuria is difficult to control, but in the early and middle stages of diabetic nephropathy, the condition of many patients can still be relieved through anti-free radicals, correction of abnormal coagulation function and lipid metabolism disorders, and combined Chinese and Western medicine treatment.