Over the years, albuminuria has been regarded as a pivotal indicator of diabetic kidney disease (DKD) and invariably precedes estimated glomerular filtration rate (eGFR) loss. Based on the studies of clinical features and renal histopathologic changes, we attempt to propose an underlying pathogenesis model and a flow chart for diagnosing normoalbuminuric phenotype. In this article, we review the latest studies addressing the epidemiology, clinical characteristics, and pathology of normoalbuminuric phenotype. Additionally, the flow of diagnosing normoalbuminuric phenotype is not perfect. Currently, the pathogenesis of normoalbuminuric phenotype remains unclear. Compared to albuminuric phenotype, normoalbuminuric phenotype has distinct clinical characteristics and a wide heterogeneity of pathological features. Epidemiological data demonstrate that normoalbuminuric phenotype is prevalent. Normoalbuminuric diabetes with renal insufficiency, which is characterized by a decline in the glomerular filtration rate in the absence of albuminuria, has been identified as an albuminuria-independent phenotype of diabetic kidney disease. In recent decades, the prevalence of diabetic kidney disease has remained stable and appears to be a wide heterogeneity.
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