【Objective】To  investigate  the  clinicopathological  characteristics  and  prognosis  of  T2DM  patients  with renal involvement.【Methods】We conducted a retrospective analysis of clinical and pathologic data from T2DM patients who received renal biopsy（n = 120），and these patients were followed up. Renal outcome is defined as receiving renal replacement therapy or progression to ESRD. 【 Results 】 Among the 120 patients with T2DM，57（47.5%）were diagnosed as DN，and 63（52.5%）as non diabetic renal disease（NDRD）. The most common subtype of NDRD is membranous nephropathy. Compared with the NDRD group，the DN group had longer course of diabetes，worse renal function and higher proportion of diabetic retinopathy. Kaplan-Meier analysis showed that the renal survival rate in DN group was significantly lower than that in NDRD group. The 1-year，5-year renal survival rate of DN group was only  81% ，41% Vs NDRD group 95，84%. After multivariate adjustment，the risk of ESRD in DN patients was 3.81 times higher than that of NDRD patients（95%CI 1.61-9.01，P=0.002）.【Conclusions】There is a risk of misdiagnosis DN by clinical manifestations， and accurate diagnosis depends on renal biopsy. The prognosis of DN patients is significantly worse than NDRD，so it is of great clinical significance to distinguish the pathological types of diabetic patients with kidney disease.