Abstract: Chronic kidney disease (CKD) is one of the most common and highly harmful chronic non-communicable diseases in China, posing a direct and significant threat to the health of the elderly population. Chronic renal fibrosis in the elderly is the most definitive and important pathological basis for the progression of CKD. In the elderly, renal fibrosis is often the result of various CKD progressing to an advanced stage, and is commonly seen in hypertensive nephrosclerosis, diabetic nephropathy, ischemic nephropathy, chronic glomerulonephritis, hyperuricemic nephropathy, drug-induced kidney injury, and obstructive nephropathy. More critically, current clinical diagnosis and treatment face multiple challenges: traditional diagnostic methods cannot accurately and early reflect the extent of renal interstitial fibrosis; existing fibrosis cannot be effectively reversed; and elderly patients often suffer from multiple comorbidities and polypharmacy. These factors collectively compound the difficulties. Therefore, exploring new diagnostic technologies and therapeutic strategies are keys to breaking through the bottlenecks in this field. This article systematically reviews the core mechanisms of the aforementioned common elderly renal fibrotic diseases, summarizes recent advances in diagnostic technologies and therapeutic strategies, and aims to provide a reference for clinical practice and future research.

Key words: aged, chronic renal fibrosis, hypertensive nephrosclerosis, diabetic nephropathy, ischemic nephropathy, anti-fibrotic therapy