Tubulointerstitial fibrosis is invariably the common pathway of chronic kidney disease (CKD) progression regardless of the initial injury.1 The severity of tubular atrophy and fibrosis on kidney biopsy are strongly predictive of progression to kidney failure; however, this damage is poorly correlated with either estimated glomerular filtration rate (eGFR) or albuminuria.2 The gold standard for evaluating kidney fibrosis is a kidney biopsy, but because of its invasive nature it is rarely used for this purpose.