The incidence and prevalence of diabetes throughout the world are rising, leading to an increase in the incidence and prevalence of diabetic nephropathy. Currently, more than 50% of patients with end-stage renal disease (ESRD) have diabetes. Although diabetes is less common among women of child-bearing age, the number of women entering pregnancy with diabetes is rising and developing kidney disease. It is usually due to classic diabetic nephropathy, which is characterized by albuminuria and progressive chronic kidney disease (CKD; i.e. proteinuria, hematuria or decreased glomerular filtration rate (GFR) for 3 or more months, irrespective of cause). This chapter covers the effect of pregnancy on diabetic kidney disease, effect of diabetic kidney disease on pregnancy, management principles, management during pregnancy, comorbidities, renal replacement therapy in pregnancy, and pregnancy in renal transplant patient.