Atherosclerosis is a generalized and inflammatory vascular disease frequently associated with renal disease and dysfunction (1) and one of the major causes of premature death in the United States today(2,3). Diverse renal vascular diseases, including atherosclerotic renal disease (ARVD), account for more than one third of all cases of ESRD.(4) Atherosclerotic plaques are present in up to 30% of patients with CKD and ARVD is among the common causes of CKD in Western societies(5,6). Atherosclerotic changes in the renal artery are evident in 50% of patients with atherosclerotic disease previously (7) and in 6.8% of adults > 65 years or age, they induce significant (>60%) renal artery stenosis.(8)In this review we discuss the pathogenesis and types of atherosclerotic renal disease in elderly including atherosclerotic renovascular disease and atheroembolic renal disease.