Diabetic kidney disease (DKD) is a significant complication of diabetes mellitus (DM), affecting a substantial portion of both type 1 and type 2 diabetes patients. It is the leading cause of end-stage renal disease (ESRD) globally, developing through a complex interplay of chronic hyperglycemia, oxidative stress, and inflammation. Early detection is crucial, with diagnosis based on persistent albuminuria and reduced estimated glomerular filtration rate (eGFR). Treatment strategies emphasize comprehensive management, including glycemic control, blood pressure regulation, and the use of nephroprotective agents such as ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 receptor agonists. Ongoing research explores novel therapies targeting molecular pathways and non-coding RNAs. Preventive measures focus on rigorous control of hyperglycemia and hypertension to mitigate disease progression. Despite therapeutic advances, DKD remains a leading cause of ESRD, highlighting the need for continued research to identify new biomarkers and innovative treatments. The article provides a comprehensive overview of the pathogenesis of DKD, including structural changes in diabetic kidneys, hyperfiltration, tubulointerstitial injury, epithelial-mesenchymal transition, inflammation, lipotoxicity, organelle dysfunction, vascular dysfunction, and epigenetic changes. It also discusses diagnostic methods, such as albuminuria testing and kidney biopsy, and management strategies, including glycemic control, lipid management, blood pressure control, dietary restrictions, and the prudent use of nephrotoxic agents. The article emphasizes the importance of early intervention and personalized therapeutic approaches to improve patient outcomes and advance the management of DKD.Diabetic kidney disease (DKD) is a significant complication of diabetes mellitus (DM), affecting a substantial portion of both type 1 and type 2 diabetes patients. It is the leading cause of end-stage renal disease (ESRD) globally, developing through a complex interplay of chronic hyperglycemia, oxidative stress, and inflammation. Early detection is crucial, with diagnosis based on persistent albuminuria and reduced estimated glomerular filtration rate (eGFR). Treatment strategies emphasize comprehensive management, including glycemic control, blood pressure regulation, and the use of nephroprotective agents such as ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 receptor agonists. Ongoing research explores novel therapies targeting molecular pathways and non-coding RNAs. Preventive measures focus on rigorous control of hyperglycemia and hypertension to mitigate disease progression. Despite therapeutic advances, DKD remains a leading cause of ESRD, highlighting the need for continued research to identify new biomarkers and innovative treatments. The article provides a comprehensive overview of the pathogenesis of DKD, including structural changes in diabetic kidneys, hyperfiltration, tubulointerstitial injury, epithelial-mesenchymal transition, inflammation, lipotoxicity, organelle dysfunction, vascular dysfunction, and epigenetic changes. It also discusses diagnostic methods, such as albuminuria testing and kidney biopsy, and management strategies, including glycemic control, lipid management, blood pressure control, dietary restrictions, and the prudent use of nephrotoxic agents. The article emphasizes the importance of early intervention and personalized therapeutic approaches to improve patient outcomes and advance the management of DKD.