We included all randomized control trials looking at individuals with diabetic kidney disease receiving direct renin inhibitors either alone or in combination with angiotensin receptor blockers or angiotensin-converting enzyme (ACE) inhibitors that provided data on any of the outcomes assessed in the current meta-analysis (urine albumin-creatinine rate, remission from microalbuminuria to normal albuminuria, progression from microalbuminuria to macroalbuminuria and all-cause mortality) relative to monotherapy with an angiotensin receptor blocker, an ACE inhibitor or placebo. This evidence concerns the gene ALB and diabetic kidney disease.