Diabetic Nephropathy (DN) is a severe kidney illness that presents with proteinuria, enlarged glomeruli, reduction in the process of glomerular filtration, and fibrosis of the kidneys. Approximately one-third of all instances of diabetes globally are brought to diabetic nephropathy, a common cause of end-stage kidney disease. In Siddha’s literature, the complications of Diabetes mellitus were expressed as ten Avathaigal in the Neerizhivu noi chapter. The feature of Avathaigal 1 to 7 depicts some of the clinical outcomes of Diabetic Nephropathy. The manifestation of clinical features in final stage Diabetic Nephropathy includes oliguria, fatigue, anorexia, nausea, vomiting, itching and dryness of skin, drowsiness, numbness and swelling in the limbs, muscle twitching or cramps, bone pain, breathlessness, increased thirst, sleep disturbance, and sexual problems. Oxidative stress is the standard mechanism involved in developing diabetic kidney disease. Most of the Siddha medicines used for managing diabetic Nephropathy are herbal formulations, and they protect against damage to the renal tubules due to their significant antioxidant property. This review summarizes the pathophysiology of Diabetic Nephropathy and the evidence for using Siddha herbal formulations to treat diabetic Nephropathy. For treating early-stage diabetic Nephropathy, Siddha practices primarily emphasize using herbal formulations; however, yoga therapy, diet, and other exercises are also included in Siddha treatment modalities.