Abstract: Objective To investigate the relationship of clinical manifestations and pathological features with prognosis of diabetic nephropathy(DN) patients with stage 4 chronic kidney disease(CKD).Methods The study subjects were those patients,who were diagnosed as DN by renal biopsy pathology with renal function in stage 4 CKD in Department of Nephrology of Chino-Japan Friendship Hospital from January 2005 to August 2019.The follow-up deadline was either the primary endpoint or until November 30,2019.The primary endpoints of observation were initiation of maintenance kidney replacement therapy,death or estimated glomerular filtration rate(eGFR) less than 15 mL·min^-1·(1.73 m²)^-1.The secondary endpoints were cardiovascular and cerebrovascular events.Based on the pathological classification of renal biopsy,the clinical and pathological parameters of the patients were respectively analyzed and survival analysis was performed.Results A total of 24 patients were included in the study,3 cases of type Ⅱa,with 3 cases of type Ⅱb,15 cases of type Ⅲ and 3 cases of type IV.The total median follow-up time was 20.7(range 5.9~72.4) months.The total median survival time was 17.3 months.7 patients with stage 4 CKD were still maintained,with the median follow-up time of 14.6(range 5.9~46.8) months;17 patients developed the primary endpoint event,with the median follow-up time of 14.2(range 6.1~72.4) months.The renal cumulative survival rates in 6 months,12 months and 18 months were 82.6%,59.3% and 41.6%,respectively.The comparison between the two groups with and without the primary endpoint events showed that systolic blood pressure and cardiovascular events were statistically different(P<0.05).Conclusions The median survival time of progression to composite kidney endpoint events in DN patients with stage 4 CKD is 17.3 months.Control level of blood pressure and cardiovascular events might be the major relevant factors in progression of renal function.