According to the latest statistics, about 92.4 million adults in China are currently at risk of diabetes. Diabetic nephropathy is a common complication of diabetes and is one of the manifestations of diabetic systemic microangiopathy. It is characterized clinically by proteinuria, hypertension, edema, and renal failure in advanced stages. Diabetic nephropathy is mostly seen in patients with a disease duration of more than 10 years. Once kidney damage occurs and persistent proteinuria develops, the disease is irreversible and often progresses to end-stage renal failure, and diabetic nephropathy has become one of the main causes of death in diabetic patients. The prevention and treatment of diabetic nephropathy (DKD) should start from primary prevention, and should focus on the prevention, monitoring and treatment of diabetes risk factors such as obesity and metabolic syndrome. In the treatment, comprehensive treatment is emphasized, highlighting its highly individualized characteristics and developing targeted therapeutic measures. 1.Control of hyperglycemia The Diabetes Control and Complication Prevention Trial (DCCT) and the UK Type 2 Diabetes Prospective Study (UKPDS) have verified that strict control of hyperglycemia can significantly reduce the occurrence of DKD and delay the progression of its course in both type l diabetes and type 2 diabetes, respectively. At present, it is believed that early intensive glycemic control with insulin in patients with newly diagnosed glucose shit disease can significantly reduce high glucose toxicity and lipotoxicity, inhibit inflammatory response, protect pancreatic islet B-cell function, thereby alleviating the disease and reducing the risk of developing chronic complications. 2, control hypertension UKPDS study shows that lowering systolic blood pressure from 154 mm Hg to 144 mm Hg in diabetic patients can reduce the incidence of proteinuria by 30%. Evidence-based medical studies have also confirmed that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) can effectively control patients’ blood pressure, reduce proteinuria, and delay the progression of renal function. For patients with DKD with hypertension, blood pressure should be controlled at 130/80 mm Hg. If the patient has significant proteinuria and/or renal impairment, blood pressure should be controlled at 125/75 mm Hg. Although the JNC7 (Joint Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension, 7th Report) guidelines for the treatment of hypertension include thiazide diuretics, B-agonal blockers, ACEI, ARB and calcium antagonists as first-line antihypertensives for DKD patients, ACEI and ARB are the drugs of choice in clinical practice. 3, correcting lipid metabolism disorder DKD patients with LDL>3.38 mmol/L and triglycerides>2 26 mmol/L should start lipid regulating therapy. Statin lipid-lowering drugs are the drugs of choice. Statin lipid-lowering drugs can not only effectively reduce hyperlipidemia, but also improve endothelial cell function and reduce cardiovascular complications through their anti-inflammatory and immunomodulatory effects; by inhibiting thylakoid cell proliferation, the extracellular matrix produces the expression of fibrinogen activity inhibitor (PAT 1). Mitigate renal lesions and delay the onset of glomerulosclerosis. In addition to hemodynamic factors, glomerular thylakoid lesions and podocyte injury play an important role in the formation and exacerbation of proteinuria in patients with DKD. The resulting mechanical tension on glomerular capillaries directly affects the expression of podocyte-associated proteins and the attachment of podocytes to the glomerular basement membrane. Therefore, ACEI and ARB can be used to treat proteinuria by improving local hemodynamic abnormalities and protecting podocyte function. 5, emerging therapeutic drugs ① Thiazolidinedione ( TZD) : TZD is a new class of drugs for the treatment of type 2 diabetes, its main mechanism: binding to peroxisome proliferator-activated receptor γ (PPARγ) located on insulin target organs such as liver, skeletal muscle and adipose tissue, regulating the transcription of many specific genes involved in lipid and glucose metabolism, the increased expression of these genes can improve insulin sensitivity. Animal experiments have confirmed that TZD analogues can reduce the rate of urinary albumin excretion in patients with early diabetic nephropathy and slow down the process of diabetic nephropathy. The mechanism may be that TZD reduces the stromal expansion in the thylakoid region of DKD patients and activates PPARγ or PPARa in thylakoid cells to play a local gene regulation role. Also, TZD can reduce triglycerides and free fatty acids, which may be one of the mechanisms of its renal protective effect. Clinical studies of pioglitazone have confirmed its ability to reduce urinary protein excretion in early DKD. Inhibitors of glycosylation end products (AGEs): AGEs are an important pathogenic factor in the development and progression of DKD. AGEs inhibitors can reduce the increase of AGEs formation induced by high glucose and inhibit the accumulation of AGEs and glucose oxidation products in tissue proteins and organs, thus slowing down the progression of diabetic nephropathy. Aminoguanidine and other AGEs inhibitors have shown good therapeutic effects in animal models. (3) Protein kinase C (PKC) inhibitors: PKC, especially PKC2β, is over-activated and involved in diabetic vasculopathy. Studies have shown that PKC2β inhibitor LY2333531 can significantly reduce glomerular thylakoid expansion, tubulointerstitial injury and glomerulosclerosis in DKD, and PKC2β inhibitor is currently in animal experimental stage. Antioxidants: Hyperglycemia-induced oxidative stress is also one of the pathogenesis of diabetic nephropathy, and there are more studies on the application of antioxidants in DKD, which can be used as adjuvant drugs for DKD. Such as vitamin E, oxalic acid, etc. 6, dialysis treatment and transplantation The treatment of renal failure in diabetic nephropathy currently favors early dialysis, while diabetic nephropathy is poorly tolerated to renal failure, early dialysis can improve the quality of life and improve the prognosis, GFR down to 15 ml/min should start dialysis. 7, kidney transplantation or combined pancreatic-renal transplantation.