【Abstract】 The clinical manifestations of diabetic kidney disease (DKD) are heterogeneous. Screening of all individuals with diabetes is recommended to detect changing levels of albuminuria and renal function, so that early renoprotective treatment can be initiated, especially in patients with type 2 diabetes. Although majority of patients with DKD had albuminuria, a significant proportion had a nonalbuminuric phenotype. Medical education should be strengthened in clinical practice to raise awareness of atypical DKD. The prognostic importance of kidney biopsy and its usefulness in identifying NDKD is an important issue that must be taken into consideration in type 2 diabetes. Pathologic classification of diabetic nephropathy by renal pathology society not only described glomerular alterations, but also provided scores for interstitial lesions and vascular lesions. New biomarkers and techniques are being developed to improve diagnostic and prognostic precision.