Abstract: Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes mellitus (DM), which often seriously affect patient prognosis and reduces quality of life. Studies have shown that energy metabolism disorders in renal tubular epithelial cells (RTECs) play a crucial role in the occurrence and development of DKD. Therefore, this article reviews and summarizes recent domestic and international research, focusing on the specific mechanisms of energy metabolism disorders in RTECs from three aspects: fatty acid oxidation (FAO) disorders, hyperactive glycolysis metabolism, and mitochondrial dysfunction. It also elaborates on the advantages and disadvantages of three representative treatment options: sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and statins. This aims to provide reference for future related research and offer new insights for the prevention and treatment of DKD.