Background:The elderly population is increasing all over the world. Several chronic diseases are observed in such aging group, including kidney diseases, and their histological patterns are not widely documented. Methods: We retrospectively reviewed native kidney biopsies (bx) evaluated in the Department of Pathology of the Federal University of Sao Paulo from 2000 to 2005, selecting 222 of patients > 65 years (ys); 128 bx had diagnosis of glomerulonephritis (GN), and 94 of renal tumors. Results: Fifty-five per cent of the patients were males, and median age was 70 ± 5 ys (range 65-90). The most frequent bx indication was hematuria (50%), followed by acute kidney injury (AKI) (20%), nephrotic syndrome (NS) (19%) and non nephrotic proteinuria (11%). Among patients with GN, mean age was 69 ± 5 ys, and 74/128, males; main bx indications were AKI (35%) and NS (33%), without statistical differences between genders for all clinical presentations. Conclusion: In this study, it was reinforced the important role of renal biopsy in elderly patients, defining main histological patterns of glomerulopathies (membranous nephropathy, amyloidosis) and other renal diseases in this age range in a Brazilian population. Besides being a useful tool for diagnosis, kidney biopsy certainly contributes to the best management of such patients.