As more information is gained on the long-term survival in chronic dialysis and transplant patients, it is unacceptable to be satisfied with a clinical impression of the etiology of the end stage renal failure in each case. It becomes important to know the histological diagnosis in patients who have terminal renal failure. In the past there was little to offer such individuals in terms of therapeutics, and their prognosis was uniformly poor. Thus, biopsy for other than academic reasons was difficult to justify. This is no longer true and presented is a series of 28 such patients in whom percutaneous renal biopsy was performed. The complications and diagnostic yield are reported. The added knowledge of histological diagnosis can be of benefit to the individual patient.