INTRODUCTION: Kidney histology preparation requires a multistep process that is usually responsible for delayed results. This study introduces dynamic full-field optical coherence tomography (D-FF-OCT) as a label-free alternative to overcome the limitations of traditional histopathology for on-site kidney pathology assessment. METHODS: Two patient cohorts were considered, with a total of 31 patients included in the study; one cohort involved patients requiring biopsy of transplant kidney, and the other involved patients requiring biopsy of native kidney. The clinical and biological data were prospectively collected. Histopathological analysis of kidney biopsies was conducted using both conventional stains and dynamic D-FF-OCT imaging. RESULTS: D-FF-OCT enabled the recognition of most kidney structures. The results showed a significant correlation between this technology and conventional stains for the evaluation of both interstitial fibrosis (IF) (r = 0.61, P < 0.001) and tubular atrophy (TA) (r = 0.60, P < 0.001). Although many lesions could be identified such as interstitial inflammation, acute tubular necrosis, glomerular crescents, and vascular intimal thickening; other recognitions such as glomerular membranous deposits, vascular amyloidosis, and peritubular capillaritis will require confirmation in larger cohorts. CONCLUSION: This study demonstrates the potential of D-FF-OCT imaging for on-site analysis of kidney biopsies, providing rapid and high-resolution images without extensive sample preparation.