In the 1980s geriatric nephrology was introduced as a subspecialty in anticipation of the increased number of elderly and very elderly people during the 21st century. There has been more clinical research dedicated to geriatric nephrology, education on the subspecialty has been implemented at national and university level, and funds for career development have been instituted over the past two decades. Our treatment of the elderly and very elderly patients seems to be more focused on their biologic age rather than chronologic age; they undergo diagnostic tests such as kidney biopsies and are candidates for kidney transplant. Although great strides have been made in the assimilation of geriatrics into nephrology more has to be done. This article examines the areas of research that encompass geriatric nephrology and clinic observations applicable to the care of the geriatric population.