Diabetic nephropathy (DN) is a growing cause of ESRD despite widely known recommendations for improved glycemic and BP control. Perhaps earlier identification of patients who have diabetes and are at high risk for DN could reverse these epidemiologic trends. Albumin excretion rate (AER), the mainstay of early detection of DN, is not a sufficiently precise predictor of DN risk. Careful family history, smoking history, consideration of absolute versus categorical AER values, more frequent AER measures, ambulatory BP monitoring, precise GFR measurements, diabetic retinopathy assessments, and plasma lipid levels all can add to predictive accuracy for DN. Thus, although further research in DN biomarkers and predictors is greatly needed, a careful integrated evaluation of currently available parameters can improve our ability to predict DN risk in individual patients.