Background: This study aimed to investigate the relationship between endothelial nitric oxide synthase (eNOS) 4b/a gene polymorphism and renal interstitial fibrosis in patients with diabetic nephropathy (DN) via a meta-analysis, in the hope of providing guidance for the genotypic detection of DN.Methods: The Boolean logic search method was adopted. A literature search of PubMed, Medline, CNKI, and other databases from inception to June 2020 was performed using the search terms "eNOS 4b/a", "diabetes", "renal interstitial fibrosis", and "kidney disease". Literatures with a DN group, a nonnephropathy diabetic group, and a normal control group were screened. Review Manager software was employed to perform the meta-analysis.Results: A total of 13 articles were included in the meta-analysis, the majority of which had a low risk of bias (i.e., medium and high quality). The results of the meta-analysis indicated that the genotypic distribution frequency of eNOS4bb in patients with DN was significantly lower than that in the nonnephropathy diabetic group (Z=3.19, P=0.001). The genotypic distribution frequency of eNOS4aa was significantly higher in non-nephropathy diabetic patients than in the normal control group (Z=2.57, P=0.01).The genotypic distribution frequency of eNOS4ba was not statistically different between patients with DN and non-nephropathy diabetic patients (Z=1.45, P=0.15). The genotypic distribution frequency of eNOS4bb in DN patients was significantly lower than that in the normal control group (Z=3.03, P=0.002); however, the genotypic distribution frequency of eNOS4ba was significantly greater than that of the normal controls (Z=2.36, P=0.02), as was that of eNOS4aa (Z=2.34, P=0.02).Conclusions: Genotypic polymorphism of eNOS 4b/a was closely related to DN. Moreover, the genotypic distribution frequency of eNOS4bb in DN renal interstitial patients was lower than that in non-nephropathy diabetic patients and normal controls.