If left untreated, diabetic nephropathy (DN) can progress to develop ESRD (end stage renal disease). Diabetic nephropathy can be complicated with coronary artery disease, hypertension, and type IV RTA, The prognosis of DN is bad with continued disease progression even after proper glycemic control.

• It is estimated that 20-40% of patients with diabetes develop diabetic nephropathy.
• The main trigger of diabetic nephropathy is chronic hyperglycemia.^[1] While a strict glycemic control reduces the rate at which microalbuminura appears and progress in patients with both type I and type II diabetes mellitus, it is debatable as to whether or not an improved blood glucose control halts the progression of renal disease once microalbuminuria is present.^[2]
• The natural history of the disease begins with the development of microalbuminuria, which usually begins 5 years after the onset of diabetes. The range for microalbuminura is 30 to 300 mg of albumin per 24 hours.
• Over the next 5-10 years, patients are more likely to develop overt proteinuria.
• Finally, over the next decade, nephrotic syndrome is more likely to occur. If left without management, diabetic nephropathy is most likely to be associated with a declining GFR and ultimately, end-stage renal disease (ESRD).
• At the point of ESRD, dialysis and kidney transplantation are the viable options for treatment.^[2]

Possible complications include:^[1]

• Coronary artery disease (CAD): In patients with diabetes mellitus, the main risk factor for the development of CAD is nephropathy^[2]
• Chronic kidney disease (CKD)
• End-stage renal disease (ESRD)
• Development and/or worsening of hypertension
• Complications related to dialysis
• Complications related to renal transplantation
• Type IV RTA: may occur in both type I and type II diabetes mellitus

Diabetic nephropathy has become the most common cause of ESRD in most countries due to the increased prevalence of diabetes epidemic.^[3] Even with medical interventions to slow the progression of microalbuminuria, diabetic nephropathy can progress to chronic kidney disease (CKD) and end-stage renal disease (ESRD).