Diabetic nephropathy has a poor prognosis. Because its kidney disease became chronic progressive damage, clinical symptoms appeared later. Generally, the course of proteinuria is more than 10 years. It has been confirmed that there is a "incubation period" in the early stage of diabetic nephropathy, and the glomerulus has changed, but there is no clinical manifestation. The only change was the increase of urinary albumin excretion rate (UAE). Once persistent proteinuria occurs in clinical diabetic nephropathy, its renal function will decline irresistibly.

About 25% patients developed end-stage renal failure within 6 years, 50% patients within 10 years, and 75% patients within 15 years. The average time from proteinuria to uremia is 10 years, and most of them die within 6 years. Diabetes is not well controlled. Hyperglycemia, hypertension and high protein diet accelerate the deterioration of renal function in patients with diabetic nephropathy.

In addition, recent observations have confirmed that smoking is also a risk factor for diabetic nephropathy. 19% of diabetic smokers have proteinuria, while only 8% of non-smokers have proteinuria. About 5% ~ 15% of diabetic patients develop uremia, but 40% ~ 50% of them are under 50 years old. Relatively speaking, the mortality rate of 26-45 years old is the highest, which is an important reason for the death of young diabetic patients. The prognosis of diabetic nephropathy is related to the nature of renal lesions, and diffuse small nodular diabetic nephropathy is easy to progress to uremia.