There are structural and functional changes which take place in the kidney with age. These changes have an impact on patient management, particularly with respect to drug therapy. It is unlikely that glomerulonephritis is less common in the elderly, and any apparent difference with respect to younger patients most likely reflects clinical practice rather than any inherent difference in the aged kidney. Tubulointerstitial nephritis may be more common and is most likely linked to drug therapy. The management of end-stage renal failure in the elderly should not be significantly different from that in younger patients and should be based on the capacity for rehabilitation rather than any arbitrary age.