Diabetes Mellitus (DM) affects almost 100 - 150 million people worldwide. It results in chronic complication like nephropathy, neuropathy and retinopathy over a period of 15 - 25 years. Diabetic nephropathy (DN), accounting for almost 25% of new cases of uremia is a leading cause of End Stage Renal Disease (ESRD) and will be discussed in detail in this article. ESTD is a devasting medical condition needing renal replacement therapy (RRT) in the form of Dialysis or renal transplant for survivial 30 - 40% of type - I and 20 - 30% of type -II diabetics will devleop DN, manifesting as persistent albuminuria, a relentless decline in glomerular filtration rate (GFR) and hypertension (HTN). the risk of death for patients with DN is nine times that of diabetics without this complication with GFR declining linearly at the rate of 1 m/min month leading to ESRD within 10 years. In the absence of any treatemtn mean survival is seven years after the development of persistent proteninuria Five years survival for diabetic ESRD patients on dialysis is poorest (17.6%) as compared to ESRD patients on dialysis due to glomerulone phritis (40.5%).