Glomeralar enlargement due to accumulation of extracellular matrix (ECM) accompanied by renal tubular basement membrane thickening and glomerular capillary ultrafiltration are very early characteristics of pathophysiology of diabetic nephropathy.

• 病理上DN早期特征性地表现为肾脏肥大、肾小球和肾小管基底膜增厚及肾小球内高灌注、高跨膜压，随着病程的进展，可逐渐发展为肾小球系膜外基质(extra cellular matrix，ECM)进行性积聚，同时伴有肾小管-间质纤维化，最终发展为不可逆性肾组织结构毁损。