糖尿病腎臟病變佔糖尿病人的20-40%並且是末期腎臟疾病(ESRD)的單一主要原因。持續的尿中白蛋白流失率在每天30到299mg之間（稱為微量白蛋白尿期），已經被顯示出是第一型糖尿病腎臟病變的最早時期並且是第二型糖尿病腎臟病變出現的指標。微量白蛋白尿也已經被證明是增加心血管疾病危險性的指標。大型前瞻性隨機的研究顯示，加強的糖尿病處置以達到接近正常的血糖為目標，可以延緩第一型和第二型糖尿病人微量白蛋白尿的發生以及延緩微量白蛋白尿進展成白蛋白尿(≧300mg/day)。在治療微量白蛋白尿和白蛋白尿時，除非在懷孕期間，應該使用血管張力素轉換酵素抑制劑或昇壓素接受器阻斷劑。就延緩腎臟病變的惡化而言，使用鈣離子阻斷劑dihydropyridine calcium channel blockers
（簡稱DCCBs）當作最初治療並不會比安慰劑更加有效。鈣離子阻斷劑在腎臟病變的使用應該限制用在輔助進一步降低那些已經接受血管張力素轉換酵素抑制劑或昇壓素接受器阻斷劑的病人的血壓。當病人無法忍受血管張力素轉換酵素抑制劑或昇壓素接受器阻斷劑時，可以考應使用non-DCCBs、β阻斷劑(β-blockers)、利尿劑(diuretics)來控制血壓。限制蛋白質的攝取在延緩白蛋白尿的惡化、腎絲球濾過率的下降、和末期腎臟疾病的發生有助益。當有腎臟病變存在時，開始限制蛋白質的攝取為每公斤體重≦0.8公克（約佔每天熱量10%）。不管尿液白蛋白的排泄程度如何，所有成年糖尿病人應該至少每年測定一次血液肌酸酐以用來估計腎絲球濾過率。單單只有血液肌酸酐不該是用來測定腎功能，而是用來估計腎絲球濾過率和對慢性腎臟病變的分期。當腎絲球濾過率小於60ml/min per 1.73平方公尺或在處理高血壓、高血鉀遇到困難時，可以考應轉診到對糖尿病腎臟病變有經驗的醫師。當腎絲球濾過率小於30ml/min per1. 73平方公尺時，建議會診腎臟科醫師。早期轉診這類的病人發現可以減低花費和改善照護品質並且維持更長的時間不用洗腎。

Diabetic nephropathy occurs in 20-40% of patients with diabetes and is the single leading cause of end-stage renal disease (ESRD). Persistent albuminuria in the range of 30-299 mg/day (microalbuminuria) has been shown to be the earliest stage of diabetic nephropathy in type 1 diabetes and a marker for development of nephropathy in type 2 diabetes. Microalbuminuria is also a well-established marker of increased cardiovascular disease (CVD) risk. Intensive diabetes management with the goal of achieving near normoglycemia has been shown in large prospective randomized studies to delay the onset of microalbuminuria and the progression of micro-to macroalbuminuria(≧300 mg/day) in patients with type 1 and type 2 diabetes. In the treatment of both micro-and macroalbuminuria, either ACE inhibitors or ARBs should be used except during pregnancy. With regards to slowing the progression of nephropathy, the use of DCCBs as initial therapy is not more effective than placebo. Their use in nephropathy should be restricted to additional therapy to further lower blood pressure in patients already treated with ACE inhibitors or ARBs. In patients unable to tolerate ACE inhibitors and/or ARBs, consider the use of non-DCCBs, β-blockers, or diuretics for the management of blood pressure. Protein restriction is of benefit in slowing the progression of albuminuria, GFR decline, and occurrence of ESRD. With presence of nephropathy, initiate protein restriction to ≦0.8g•kg body wt^(-1)•day^(-1) (10% of daily calories). Serum creatinine should be measured at least annually for the estimation of GFR in all adults with diabetes regardless of the degree of urine albumin excretion. Serum creatinine alone should not be used as a measure of kidney function, but used to estimate GFR and stage the level of CKD. Consider referral to a physician experienced in the care of diabetic renal disease either when the GFR has fallen to <60 ml/min per 1.73 m^2 or if difficulties occur in the management of hypertension or hyperkalemia. It is suggested that consultation with a nephrologist be obtained when the GFR is <30 ml/min per 1.73 m^2. Early referral of such patients has been found to reduce cost and improve quality of care and keep people off dialysis longer.