Diabetic nephropathy is a leading cause of end-stage renal disease. Recently, there have been developments in understanding the role of risk factors and pathogenetic features such as genetic predisposition, systemic and intraglomerular hypertension, the effects of glycemic control, glomerular hypertrophy, and basic biochemical alterations in cellular metabolism, as well as correlations in morphology and function. These are reflected in newer approaches to preventive and palliative therapy.