Electron microscopy: A Game-Changer for Diagnosing Kidney Disease? The electron microscope (EM) provides detailed images of cells, tissues, and organelles, making it an invaluable tool in laboratories. As a result, this technique is widely employed in the diagnosis of kidney diseases. But is EM truly the game-changer we perceive it to be? Our research aimed to assess the added value of EM in diagnosing primary kidney diseases. For this, 470 pathology reports were reevaluated, which included 514 cases due to multiple diseases in some patients. The diagnoses before and after EM were compared. In 8.7% of the cases, where EM was executed and successful, EM was found necessary for diagnosis. In most cases (79.7%), where EM was executed and successful, the EM confirmed the diagnoses that had already been established using light microscopy (LM) or immunofluorescence (IF). To further examine the value of EM, we distributed a questionnaire among nephrologists. The results revealed that 44% of the nephrologists altered their diagnosis, in 5% to 10% of the biopsies, after receiving the EM report. The biggest barrier the nephrologists faced, in ordering EM, was the long wait before receiving the EM report. Additionally, most nephrologists (68%) changed their already instituted therapy in less than 5% of cases after receiving the EM report. But why is it crucial to establish an accurate diagnosis along with the appropriate therapy? Approximately 10% of the world's population is afflicted by kidney disease, a number that is projected to make the fifth leading cause of death by 2040, as estimated by scientists. In the advanced stages of these diseases, the necessity for renal replacement therapy, for example dialysis, or kidney transplantation may become unavoidable. This has enormous social and economic implications. Therefore, conducting scientific research to improve the diagnostic accuracy and treatment of kidney diseases is imperative. Not only does the deterioration of the patient's condition have major economic consequences, the use of EM is also costly. Further research is essential to determine if, in situations where EM functions as a confirmation tool, the additional information affects patient care. Careful consideration must be given to the specific conditions in which EM is indicated. It is crucial to employ this powerful tool only when it aids in making a diagnosis or provides new information that impacts the patient’s health.