Diabetic nephropathy is the leading cause of renal failure in UK, accounting for 24% of patients with end-stage renal disease (ESRD). In addition, it is a risk factor for cardiovascular disease. Clinical trials have shown that it is possible to alter the natural history of diabetic nephropathy by targeting multiple risk factors. In clinical practice, this includes tight glycaemic control, aggressive antihypertensive therapy and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). This article aims to describe management of diabetic nephropathy in primary care and provide guidance on when to refer to secondary care.