What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?  

Rapid deterioration of kidney function Rapid worsening of proteinuria especially if there is severe nephrosis, hypoalbuminemia with edema Active nephritic pattern of kidney injury Virtually any other glomerulonephritis can happen on a background of diabetic nephropathy. So when suspicion for an...

Nephrotic range proteinuria or nephrotic syndrome Persistent sterile pyuria or microscopic hematuria Rapid decline in kidney function not consistent with the course of diabetic kidney disease Acute kidney injury superimposed on chronic kidney disease with differential diagnosis including drug-i...

Agree with Barbara @Barbara and @Arun’s answers.