d-Serine, a long-term undetected enantiomer of serine, is now showing its potential as a biomarker for kidney diseases. The intra-body dynamics of d-serine, currently defined by blood levels and urinary excretion dynamics, are useful for a comprehensive assessment of kidney function and disease activity. Thus, widespread adoption of d-serine as a biomarker can resolve the long-standing clinical challenge of the early detection and prognostic prediction of kidney diseases. Accuracy and reliability of the measurements are particularly important because these measurements will affect treatment decisions and thus impact the patient's emotional state and quality of life. Accordingly, this review focuses on current clinical challenges in kidney diseases and the potential for monitoring of d-serine to overcome these issues, and discuss the requirements of accurate quantification.