Background   Type 2 diabetes with different types of nephropathy is easy to be complicated with fundus lesions, and its early diagnosis directly affects the treatment and prognosis of patients.

  Objective  To observe the fundus manifestations of type 2 diabetic patients with different types of nephropathy, so as to provide reference for clinical diagnosis.

  Methods  Clinical data about type 2 diabetic patients complicated with nephropathy admitted to Department of Ophthalmology, the First Medical Center, Chinese PLA General Hospital from January 2017 to December 2021 were collected. The pathological classification of nephropathy was determined by renal biopsy. Fundus lesions were diagnosed by fundus examination. Results A total of 124 patients with type 2 diabetic patients complicated with nephropathy were selected. Seventy-two cases were male and 52 cases were female, with an average age of 45.5 ± 7.6 years. Seven types of nephropathy were diagnosed by the pathology examination, and the the features of color fundus images varied. The fundus image of diabetes nephropathy (DN) showed obvious changes of diabetes retinopathy. Membrane nephropathy (IMN) had no pathological changes or only microangioma and posterior pole lesions. Immunoglobulin A nephropathy (IgAN), mainly with slight changes of retinal arteriosclerosis or with posterior pole lesions. Glomerular minimal change nephropathy (MCD) was characterized by retinal pigment epithelial disease. Hypertensive nephropathy was the same as hypertensive retinopathy, with focal glomerulopathy, no abnormality in fundus, or only posterior pole lesion. Purpura nephropathy was characterized by microangioma in the macular region and white line changes in veins.

  Conclusion  The features of color fundus images of diabetes complicated with different pathological types of nephropathy are significantly different, and each type has specific manifestations. The identification of different fundus manifestations will benefit early diagnosis.