Abstract: Diabetic kidney disease(DKD) is a serious complication of diabetes, and its prevalence has been high. Studying the pathogenesis of diabetic nephropathy is helpful to find effective ways to treat DKD.It is now clear that the pathogenesis of DKD is associated with abnormal glucose metabolism, inflammatory response, oxidative stress, endoplasmic reticulum stress, autophagy,and exosomes. Among them, autophagy is a stress-responsive intracellular system that can attenuate autophagy by activating mTOR and reducing AMPK and Sirt1, which may lead to new targets for DKD treatments.Exosomes contain proteins, DNA and RNA derived from cells, which can reflect the physiological state of the source cells and have potential as a diagnostic marker for DKD.This article reviews the pathogenesis of DKD.