Fifty years after the first percutaneous needle biopsies of the kidney, enough results have been obtained to evaluate indications in elderly patients, a population group we define as over 75 years of age. In approximately 50% of the patients in this group, the indication for renal biposy is a nephrotic syndrome. The lesions usually observed involve extramembranous glomerulonephritis or minimal change glomerulopathy. The biopsy may also reveal amylosis. Chronic renal failure is the predominant reason for nephrology consultation in the elderly. Although all of these patients do not undergo biopsy, in our experience, results show chronic glomerulopathies, mainly IgA, in about half of the case as well as chronic interstitial nephritis and nephroangiosclerosis. The aging process also leads to acute renal failure in many patients. Biopsy would not be indicated in case of shock, drug toxicity or obstruction but in approximately 10% of the cases histology can reveal a specific parenchymal lesion. The technique for renal biopsy is the same in elderly patients as in younger adults. Renal biopsy can be considered as a safe diagnostic tool of considerable importance when ordered by a nephrologist, performed by an experienced operator and read by a well-trained pathologist. In many cases it is essential to in order to provide patients over 75 with the same quality care as younger adults.