Objectives: It is challenging to distinguish diabetic nephropathy (DN) from other glomerular diseases in diabetic patients without diabetic retinopathy (DR). The aim of this study was to compare the clinical, laboratory, and pathological differences between patients with and without DR in those with histologically diagnosed DN. Methods: We investigated clinical, laboratory, and pathological findings of 121 patients with type 2 diabetes who were diagnosed as DN through kidney biopsy. Results: Among the participants, 79 (65.2%) had DR and 42 (34.8%) showed no evidence of DR. Compared to patients without DR, patients with DR were younger (p = 0.004), and had a higher prevalence of diabetic neuropathy (p = 0.002) and peripheral edema (p = 0.014). In laboratory findings, patients with DR had lower hemoglobin (g/dL, p = 0.001), serum albumin (g/dL, p = 0.001), complement 3 levels (mg/dL, p = 0.027); higher platelet distribution width (PDW, fl, p = 0.026), serum creatinine (mg/dL, p = 0.029), cystatin C (mg/L, p < 0.001), uric acid (mg/dL, p = 0.016), urine protein to creatinine ratio (mg/g, p < 0.001), serum potassium (mEq/L, p = 0.002), total cholesterol (mg/dL, p = 0.044) and low density lipoprotein (mg/dL, p < 0.001). In pathological findings, patients with DR had a higher grade of pathological classification of DN (p = 0.009). Moreover, a multivariable analysis revealed that a higher PDW was significantly associated with DR (OR: 1.374, 95% CI: 1.030-1.833, p = 0.031). Conclusions: The presence of DR in diabetic patients may be associated with severe kidney damage. In addition, a higher PDW is be more likely to be accompanied by DR, which in turn may be related to severe microvascular complications. Given this, it is possible that there are slightly different mechanisms contributing to DN in diabetic patients without DR compared to those with DR.