To determine the spectrum and the relative frequencies of different pulmonary diseases in chronic renal failure (CFR) patients, we reviewed autopsy records from 46 chronic hemodialysis patients with end-stage renal disease of various etiologies. Pathological abnormalities were observed in the lungs of all but one patient. Acute and chronic lung diseases were found in 95.7% and 80.4% of subjects respectively. The most common acute diseases were pulmonary infections (pneumonia, lung abscess, empyema) and fluid overload. The most common chronic process was interstitial fibrosis. Other relatively common chronic diseases included pleural fibrosis and/or pleuritis as well as pulmonary arteriosclerosis, hemorrhage, thromboembolism and calcification. The incidences of granulomatous lung diseases, pulmonary amyloidosis and metastatic lung tumors were also higher than expected. Relative incidences of the different pulmonary diseases did not appear to be related to the etiology of CFR; rather, lung abnormalities were common in CFR of all etiologies.