Global Patterns, Prevalence and Evidence-Based Management of Biopsy-Proven Renal Diseases: A Comprehensive Review

Biopsy-proven renal diseases constitute an important subset of intrinsic kidney diseases and contribute substantially to chronic kidney disease and kidney failure worldwide. Renal biopsy remains the gold standard for diagnosing intrinsic kidney disease, providing histopathological information that guides diagnosis, prognosis, and individualized therapy. Epidemiology varies considerably by region due to genetics, ethnicity, environmental exposure, socioeconomic status, and biopsy practices, with IgA nephropathy frequently reported as a predominant primary glomerular disease in East Asia and several European populations, while focal segmental glomerulosclerosis is frequently reported in North American and African biopsy cohorts. Secondary glomerular diseases, including lupus nephritis and diabetic kidney disease, remain a substantial proportion of biopsy-confirmed disorders globally. Recent international clinical practice guidelines, including the 2025 update to global kidney disease guidelines for IgA nephropathy and IgA vasculitis, have transformed care, emphasizing early diagnosis, optimized supportive therapy, risk stratification, and disease-specific pharmacological intervention. Recent therapeutic advances, including sodium-glucose cotransporter-2 inhibitors, finerenone, targeted-release budesonide, sparsentan, rituximab, and emerging complement-targeted therapies, have expanded disease-specific and supportive treatment options and demonstrated renal and/or proteinuria benefits in selected kidney diseases. This review synthesizes worldwide prevalence data from major kidney biopsy registries and critically evaluates current evidence-based management strategies across the principal biopsy-proven renal diseases, highlighting regional variation, therapeutic advances, and priorities for future research.