Patient-Derived Stem Cell Therapy for Diabetic Kidney Disease

Inclusion Criteria: * Diabetes mellitus (on anti-diabetes drug therapy) * Age 45-75 years * eGFR 25-55 ml/min/1.73m2 at time of consent with: a) eGFR decline of 5 ml/min over 18 months or 10 ml/min over 3 years or b) an intermediate or high 5-year risk of progression to end-stage kidney failure (dialysis or transplant) based on the validated Tangri 4-variable (age, sex, eGFR, urinary albumin-creatinine ratio) kidney failure risk equation https://kidneyfailurerisk.com/ * Primary cause of kidney disease is diabetes without suspicion of concomitant kidney disease beyond hypertension * Spot urine albumin:creatinine ≥30 mg/g unless on RAAS inhibition * Ability to give informed consent Exclusion Criteria: * Hemoglobin A1c≥11% * Pregnancy * Active malignancy * Active Immunosuppression therapy * Kidney transplantation history * Concomitant glomerulonephritis * Nephrotic syndrome * Solid organ transplantation history * Autosomal dominant or recessive polycystic kidney disease * Known renovascular disease * Kidney failure (hemodialysis, peritoneal dialysis, or kidney transplantation) * Active tobacco use * Body weight \>150 kg or BMI\>50 * Uncontrolled hypertension: Systolic blood pressure (SBP) \>180 mmHg despite antihypertensive therapy * Recent cardiovascular event (myocardial infarction, stroke, congestive heart failure within 6 months * Evidence of hepatitis B or C, or HIV infection, chronic * Anticoagulation therapy requiring heparin bridging for procedures. * History of methicillin-resistant staphylococcus aureus colonization * Recent plastic, chemical or surgical manipulation of adipose tissue for cosmetic purposes within 6 months * Inability to give informed consent * Potentially unreliable subjects and those judged by the investigator to be unsuitable for the study