Diabetic nephropathy is an important clinical entity in the geriatric population. One half of newly enrolled patients in dialysis programs have non-insulin-dependent diabetes mellitus (NIDDM), and the number of NIDDM patients with chronic renal insufficiency is estimated to be eight times greater than those with insulin-dependent diabetes mellitus. In view of this growth potential, this paper is intended to briefly review the epidemiology and pathogenesis of diabetic nephropathy, and to highlight some important considerations in the clinical evaluation and treatment of patients with NIDDM.