Background: Diabetic kidney disease (DKD) is one of the leading causes of chronic kidney disease and kidney failure worldwide. Although most patients with diabetes are diagnosed clinically on the basis of albuminuria, estimated glomerular filtration rate decline, and diabetic retinopathy, clinical parameters alone may not reliably distinguish biopsy-proven diabetic nephropathy (DN) from non-diabetic kidney disease (NDKD) or mixed lesions. The role of kidney biopsy in diabetic patients therefore remains selective rather than routine, but its diagnostic and prognostic value is increasingly relevant in precision nephrology. Methods: This narrative review summarizes clinicopathological evidence on kidney biopsy in patients with diabetes, with particular emphasis on the Renal Pathology Society classification of DN, the prognostic significance of glomerular, tubulointerstitial, and vascular lesions, indications for biopsy, and emerging digital and molecular approaches to renal tissue assessment. Results: Histopathological evaluation provides information that cannot be fully captured by routine clinical markers. While glomerular lesions remain central to the classification of DN, tubulointerstitial fibrosis and tubular atrophy are among the strongest predictors of kidney disease progression. Vascular lesions, particularly arteriolar hyalinosis, also carry renal and cardiovascular prognostic significance. Kidney biopsy is especially valuable in patients with atypical clinical features, including rapid decline in kidney function, acute-onset nephrotic-range proteinuria, active urinary sediment, short diabetes duration, absence of diabetic retinopathy, or suspicion of immune-mediated glomerular disease. In these settings, biopsy may identify NDKD or mixed DN/NDKD, with direct therapeutic implications, including the potential use of disease-specific or immunosuppressive treatment. Emerging technologies, including artificial intelligence-assisted digital pathology, spatial transcriptomics, multi-omics profiling, and biomarker-based “virtual biopsy” models, may further refine lesion quantification and risk stratification, although they currently complement rather than replace tissue-based diagnosis. Conclusions: Kidney biopsy remains a clinically important tool in selected patients with diabetes. Beyond confirming DN, it enables the detection of NDKD, improves prognostic stratification, and supports individualized therapeutic decision-making. A selective, indication-driven biopsy strategy should be regarded as an essential component of precision nephrology in DKD, particularly as histopathology becomes increasingly integrated with digital, molecular, and computational approaches.

Background: The Falls Efficacy Scale-International (FES-I) is an assessment tool designed to measure the level of fear of falling in older adults. This scale was developed to evaluate how much an individual fears falling during various daily activities. The aim of the study was to assess the discriminatory power of FES-I to predict falls within 2 years. The secondary objective was to evaluate the relationship between FES-I and vascular status. Material and Methods: In this prospective study, 130 patients (mean age, 64.7 ± 14.6 years) with chronic kidney disease (CKD) were analyzed. Of these, 90 patients had nondialysis CKD: 15 had stage G3 (G3a, n = 5; G3b, n = 10), 38 had stage G4, and 37 had stage G5. The remaining 40 patients (30.7%) were prevalent patients receiving maintenance hemodialysis. The most frequent cause of CKD was hypertension and diabetes in 57 (43.8%) of patients. The Falls Efficacy Scale-International (FES-I) was used to assess fear of falling. The Charlson Comorbidity Index (CCI) was used to measure comorbidity, and the 10-year cardiovascular risk was assessed using a web-based calculator QRESEARCH Cardiovascular Risk Algorithm, version 3 (QRISK^®3), and hemodynamic parameters were measured using a Mobil-O-Graph monitor. Participants were followed for 2 years to assess the occurrence of falls. Results: During the two-year follow-up, 49 of 130 participants (37.7%) experienced at least one fall. FES-I demonstrated good discrimination for falls (AUC 0.836; bootstrap 95% CI, 0.760–0.903). In multivariable logistic regression adjusted for age, sex, dialysis status, comorbidity, and functional status, FES-I remained independently associated with falls (adjusted OR per 1-point increase, 1.145; 95% CI, 1.060–1.237; p < 0.001). Addition of FES-I to the basic clinical model increased the AUC from 0.826 to 0.874, although the difference was of borderline statistical significance in paired receiver operating characteristics (ROC) comparison (p = 0.053). The data-derived Youden-optimal threshold was 25 points; however, bootstrap analysis indicated threshold variability, and this cut-off should be considered exploratory. Conclusions: Higher FES-I scores were independently associated with falls during two-year follow-up and may provide additional prognostic information beyond selected clinical risk factors. FES-I may represent a candidate screening instrument for fall-risk assessment in CKD; however, the proposed cut-off (25 points) requires prospective external validation.

Background: Chronic kidney disease (CKD) affects up to 40% of individuals with diabetes mellitus. Given the fact that CKD in diabetics may result from various non-diabetic renal disorders, kidney biopsy remains essential in cases with atypical clinical presentation. The aim of this study was to assess the prevalence of diabetic nephropathy (DN) and other non-diabetic kidney diseases (NDKD) among diabetic patients who underwent renal biopsy. We also tried to find clinical and laboratory markers predicting the presence of DN in renal tissue. Methods: A retrospective analysis of all native renal biopsies in diabetic patients performed between 2010 and 2024 in one European nephrology center. Results: The cohort included 115 diabetic patients. DN was diagnosed in 43.5% individuals. Among NDKD cases, vasculitis (8.7%), membranous nephropathy (7.8%), and amyloidosis (7.8%) were most frequent. Compared with the NDKD group, patients with DN were younger, had a longer duration of DM, more often required insulin therapy, more frequently demonstrated diabetic retinopathy (DR) and nephrotic syndrome, and exhibited higher HbA1c levels. In multivariable logistic regression, younger age, need for insulin therapy, and presence of DR were the strongest predictors of DN. Conclusions: NDKD is common among DM patients. Patient’s younger age, the need for insulin therapy, and the presence of DR are strong predictive markers for diabetic nephropathy. Renal biopsy remains the most accurate method for diagnosis and should be considered in every case of suspected NDKD.