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Individuals aged >65 years are the fastest expanding population demographic throughout the developed world. Consequently, more aged patients are receiving diagnoses of impaired renal function and ‘nephrosclerosis’ - age associated histological changes in the kidneys. Recent studies have shown that the aged kidney undergoes a range of structural changes and has altered transcriptomic, haemodynamic and physiologic behaviour at rest and in response to renal insults. These changes impair the ability of the kidney to withstand and recover from injury, contributing to the high susceptibility of the aged population to acute kidney injury, and their increased propensity to develop subsequent progressive chronic kidney disease. This review examines these features of the aged kidney, and explores the various proven and putative pathways contributing to the changes seen with aging in both experimental animal models and in man. The potential for further study to increase understanding of the aged kidney, and to lead to novel therapeutic strategies is discussed.