The objective is study of the progression of diabetic nephropathy (DN) among Saudi patients with type 2 diabetes mellitus (DM). This is a prospective cohort study of 35 Saudi patients with biopsy proven DN. A scoring system for the histological severity was developed and assessed blindly. The following parameters were recorded at baseline, and after a mean FU period of 8.2 years: age, gender, GFR (using chromium labeled EDTA, serum creatinine, BMI, urinary protein and serum albumin. The mean age was 60.7 years. There were 20 males and 15 females. The mean baseline EDTA GFR was 43.8 mls /min +/- 28.8.) And the mean baseline serum creatinine was 165.3 (+/- 115.6). The mean albumin at baseline was 29.4 grams /L (+/-9.8) and the mean proteinuria was 3.4 grams in 24 hours (+/-2.3). Twenty patients (57.1%) required dialysis within two years of follow up. Four patients (11.4 %) died, 9 (25.7%) remained off dialysis with mean serum creatinine of 119.7 umol/L at the end of the follow up period of 8.2 years. Two patients were lost to follow. The factors found significantly associated with progression were higher baseline proteinuria (p=0.01), serum creatinine (p=0.01) and score of histological severity (p<0.001); and lower baseline serum albumin (p=0.001, EDTA GFR (p=0.001) and BMI (p=0.001) and higher. In conclusion, DN due to type 2 DM in Saudi patients has a rapid course. Histological parameters associated with progression were identified. This study involves a small group and the results require confirmation.