stress, inflammation and fibrosis. As injury worsens, kidney function decreases and glomerular basement membrane (GBM) become more permeable and less efficient at filtration. This is accompanied by a steady decline in kidney function. Diagnosis Diagnosis is based on the measurement of abnormal levels of urinary albumin in a diabetic coupled with exclusion of other causes of albuminuria. Albumin measurements are defined as follows: Normal albuminuria: urinary albumin excretion <30 mg/24h; Microalbuminuria: urinary albumin excretion in the range of 30–299 mg/24h; Macroalbuminuria: urinary albumin excretion ≥300 mg/24h Urinary albumin excretion can also be measured by urinary albumin/creatinine ratio in a spot urine sample, which is as accurate but more convenient than a 24-hour urine collection. It is recommended that diabetics have their albumin levels checked annually, beginning immediately after a diagnosis of type 2 diabetes and five years after a diagnosis of type 1 diabetes. Medical imaging of the kidneys, generally by ultrasonography, is recommended as part of a differential diagnosis if there is suspicion of urinary tract obstruction, urinary tract infection, kidney stones or polycystic kidney disease. Conformation kidney biopsy should only be performed if non-diabetic kidney disease is suspected. Urine analysis in patients with diabetic kidney disease is often bland. In cases of severely increased microalbuminuria, hematuria might be present. fat bodies might be present in patients who develop nephrotic-range proteinuria. Staging To clinically stage the degree of damage in this (and any) kidney disease, the serum creatinine is determined and used to calculate the estimated glomerular filtration rate (eGFR). Normal eGFR is equal to or greater than 90ml/min/1.73 m2. On biopsy, the following classification has been suggested by Tervaert et al.: Biomarkers Although albuminuria is the most frequently used marker of DN, it has a limited sensitivity as many patients with diabetic nephropathy experience GFR loss and glomerulosclerosis without immediate elevation in albuminuria. Many novel markers are currently being studied that potentially detect diabetic nephropathy at earlier stages and identify progression risk. Cystatin C is a protein that is freely filtered in the glomeruli before it is reabsorbed and catabolized in the renal tubular cells. Its serum level is independent of muscle mass, making more accurate at estimating GFR than creatinine serum levels. Treatment The goals of treatment are to slow the progression of kidney damage and control related complications. Management of diabetic nephropathy currently centers over four main areas: Cardiovascular risk reduction, glycemic control, blood pressure control