Objective To observe the pathological features of diabetic tubulopathy (DT) and analyze the relationship between interstitial fibrosis and tubular atrophy (IFTA) scores and poor disease prognosis. Methods The pathological types, basic data, laboratory examination indexes and follow-up of 121 patients diagnosed as diabetic tubulopathy by pathological biopsy from 2018-2021 at the Army Specialized Medical Center of Army Medical University were collected and retrospectively analyzed. The patients were divided into 3 groups according to the different IFTA scores: group 1 (n=20), group 2 (n=55), and group 3 (n=46). Adverse prognosis was based on the occurrence of endpoint events. Differences between clinical and laboratory data of each group were compared, and correlation analysis was performed between IFTA and glomerular injury, interstitial inflammation, renal artery vitreous lesion and renal arteriosclerosis. Cox regression analysis was used to assess the relationship between IFTA scores and endpoint events. Results The age of 121 DT patients was (53.0±10.2) years old, including 84 males and 37 females, and 99 cases of the 121 patients were with hypertension (81.8%). The incidence of nocturia, lower limb edema, proteinuria, and diabetic retinopathy increased with increasing IFTA score (P<0.01), and urinary microalbumin, urinary protein quantification, urinary albumin creatinine ratio (ACR), corrected urinary N-acyl-β-D-amino glucosidase (NAG), cystatin C (CYC), and blood creatinine levels showed increasing trend (P<0.01), and urinary creatinine (Ucr) and estimated glomerular filtration rate (eGFR) levels gradually decreased (P<0.01), but there was no statistically significant difference between the development of complications such as coronary heart disease, cerebrovascular disease, and chronic liver disease and high IFTA scores (P>0.05). Among pathological changes, IFTA score was strongly correlated with glomerular injury (r=0.503, P=0.000), and renal artery vitreous changes (r=0.329, P=0.007). There was a positive correlation between IFTA score and poor prognosis of patients (model-corrected P=0.021, HR=2.740, 95%CI 1.167-6.410), where the risk of adverse prognosis was 2.740 times higher in patients with IFTA score 3 than in patients with IFTA score 1. Conclusion Glomerular injury, renal artery vitreous degeneration, and renal arteriosclerosis scores were closely associated with IFTA scores in DT, and IFTA scores were closely associated with poor prognosis in DT patients.