Nephropathy is one of the most common diabetic microvascular complications. Without specific intervention, patients with diabetes with microalbuminuria can progress to end-stage renal disease (ESRD) within 10 to 20 years. At greater risk are ethnic minority populations that are disproportionately affected by diabetic nephropathy and subsequent complications. Early detection and treatment can attenuate the progression of nephropathy to ESRD, and a variety of screening techniques are used to this end. Microalbuminuria has been recognized as an early predictor of nephropathy and has become an important screening target. There are 3 common methods of screening used to detect microalbuminuria: measurement of albumin-to-creatinine ratio in random spot collection, a 24-hour urine collection with creatinine, and a timed (4 hour or overnight) collection. Glomerular filtration rate (GFR) may also predict progression of nephropathy because it can indicate underlying glomerular hyperfiltration and hypertension. Kidney function is best estimated by GFR, and the stages of chronic kidney disease are determined by respective GFR levels. GFR can be estimated with predictive equations or a 24-hour urine sample or measured directly using insulin. The National Kidney Foundation and the American Diabetes Association have developed clinical guidelines that detail a screening protocol to be used for patients with diabetes. This article examines the current guidelines and the issues surrounding screening for diabetic nephropathy, including the link with diabetic retinopathy, discusses the prediction of progression, and also provides an algorithm for primary care diagnosis of kidney disease.