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When possible complications of immunosuppressive treatment add on these concerns, some clinicians prefer conservative methods without performing renal biopsy. Some other clinicians on the other hand try empiric immunosuppressive treatment without biopsy. Yoon et al[18] evaluated this subject in their study. They evaluated renal and patient survival rates of 99 patients (age > 60 years) presenting with nephrotic syndrome who were grouped as those who had renal biopsy (n = 64) and those who did not (n = 35). The major Lenvatinib cost defect of this study was the lower mean age and better renal functions in the group who had renal biopsy. Although complete remission was more frequent (45% vs 26%, P = 0.013) in the biopsy group in which statistically significantly more patients had immunosuppressive therapy (P PIK-3 lower in the group without biopsy which was not a surprise considering significantly higher mean age. On the other hand, there are factors that lead the clinician towards biopsy like need of urgent diagnosis for optimum treatment of pauci-immune glomerulonephritides presenting as RPGN; the risk of not giving specific treatment considering more susceptibility of elderly to infective and thrombotic complications of nephrotic syndrome[19,20]; prevention of unnecessary treatments by renal biopsy; and provision of prognostic Small Molecule Compound Library data. Studies with very elderly patients revealed that therapeutic approach may change 40%-67% with renal biopsy[11,14]. So, advanced age should not be the sole contraindication for renal biopsy. The clinician has to decide respecting the preference of the patient within this multifactorial equation. Renal biopsy in elderly has the potential to be problematic for pathologists as well as clinicians. Varying degrees of ��background�� glomerulosclerosis, tubular atrophy, arteriolar hyalinosis that may be seen as a result of both senility and co-morbidities may superimpose primary and secondary glomerular diseases[21]. Primary glomerular diseases in the elderly present as nephrotic syndrome, nephritic syndrome, RPGN, asymptomatic urine abnormalities or chronic glomerulonephritis as in other age groups. But nephrotic syndrome and acute nephritic syndrome including RPGN comprises most of the cases as can be understood from biopsy indications in reported by biopsy series. PGDs causing nephrotic syndrome are MN, FSGS and MDH, while MPGN, IgAN and pauci-immune crescentic GNs comprise the major causes of nephritic syndrome. But different and complex forms of presentation are not rare. As an example, AKI superimposed on nephrotic syndrome is more frequent in elderly population.