Kidney biopsy in diabetic kidney disease. Yes, but in very selected cases.

The debate on kidney biopsy in diabetic kidney disease (DKD) is multifaceted. Loreto Gesualdo and colleagues argue for its broader application, claiming that biopsies can offer precise diagnostic data and guide personalized treatment plans. On the other hand, Alberto Ortiz opposes this, citing insufficient evidence, resource constraints and potential risks. He suggests that alternative diagnostic methods, such as advanced imaging techniques and serological markers, will obviate the need for biopsy in most patients. Both sides agree on the need for individualized patient care, and open discussions between healthcare providers and patients about the procedure's risks and benefits. The application of kidney biopsy in these patients needs to consider clinical evidence, practical limitations and patient preferences, and demands a balanced, case-by-case approach. Overall, this moderator believes that, although fundamental in clinical research, kidney biopsy in DKD is infrequently needed.