As the population ages, greater numbers of elderly patients will present with kidney diseases. Many kidney diseases, such as IgA nephropathy, will require kidney biopsy for diagnostic confirmation, treatment guidance and prognostication. In this paper, we review the current and expected future healthcare landscape with a focus on the ageing population, pros and cons of kidney biopsy in elderly patients, as well as treatment strategies and precautions. We also review the available data on IgA nephropathy in the elderly, including its occurrence rate based on the kidney biopsy, clinicohistopathological features, differentiation with IgA-dominant postinfectious glomerulonephritis, treatment options and outcome prediction. Overall, information on kidney diseases in patients with advanced age, including IgA nephropathy, is limited. Clinical evaluation and management strategies are extrapolated largely from studies in younger adults. Age-specific clinical and translational investigations of kidney diseases are eminently needed.