Background: The kidney biopsy is the gold standard for the diagnosis of glomerular diseases. Large-scale, epidemiological studies describing the prevalence of kidney diseases are lacking especially in the US. We aimed to determine the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. Methods: We identified all patients with a native kidney biopsy performed/reviewed at the Cleveland Clinic from January 2015 to September 2021. Retrospective chart review was performed to obtain clinical and demographic characteristics. Results were stratified by age, gender, race and location to determine epidemiological trends. Results: Of over 9600 patients, we excluded transplant/donor biopsies and unavailable records, and included 4128 patients with native kidney biopsy data. The median age was 60 years, with 46.2% female patients. Self-reported racial demographics included 72.9% White, 21.7% Black, 3.1% multi-racial, and 1.6% Asian background, with 5.1% Hispanic. Common diagnoses were: FSGS (n=633, 15.3%), diabetic kidney disease (DKD) (n=602, 14.6%), IgA nephropathy (n=319, 7.7%), lupus nephritis (LN) (n=289, 7.0%), pauci-immune glomerulonephritis (n=275, 6.7%), membranous nephropathy (n=211, 5.1%), and amyloidosis (n=110, 2.7%). There were 3322 patients in Ohio, with 361 patients in Florida. Using multivariate analysis, those over 70 years were more likely to have FSGS, while those less than 45 years were more likely to have IgA Nephropathy or LN. Males were more likely to have FSGS or IgAN and less likely to have LN. Blacks were more likely to have FSGS, DKD or LN. Hispanics were more likely to have DKD. Finally, patients in Florida were more likely to have LN. There was no change in the disease spectrum prior to and during the COVID 19 pandemic. Conclusion: Our study catalogues the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. This lays the foundation for glomerular disease clinical trials and highlights the need for a standardized national kidney biopsy registry to bolster glomerular and kidney disease research in the United States.