There are striking epidemiological differences even between European countries, the proportion of patients admitted to renal replacement therapy exceeds the figures reported by US. In Heidelberg (Southwestern Germany), 59% of patients admitted to renal replacement therapy in 1995 they had diabetes and 90% of them had type 2 DM. An increase in end-stage renal disease (ESRD) of type 2 DM has been observed with a notoriously low incidence of type 2 DM. Histopathological changes associated with diabetic nephropathy in 106 of 168 patients with type 1 or type 2 diabetes. However, 20 of the 106 patients had no clinical manifestations of diabetic nephropathy in their lifetime.