To provide a realistic picture of the patient case load of a pediatric nephrologist in a teaching hospital, we analyzed the number, the demographics, and the reasons for patient referral to our pediatric nephrology program over a 10-year period. Between January 1, 1978, and December 31, 1987, 1,523 pediatric patients were referred to the Medical College of Virginia for evaluation and treatment of renal and electrolyte disorders. The most common reason for referral was a fluid-electrolyte disorder (30%), followed by hematuria/proteinuria (22%), chronic glomerulonephropathies (10%), hypertension (5%), nephrotic syndrome (6%), end-stage renal disease (3%), urinary tract infections (5%), and acute glomerulonephritis (3%). More than 25% of the patients were under 1 year of age at initial presentation. The rest are equally distributed among the other pediatric age groups, including adolescents. Fifty-eight percent of these patients were white, and 41% were black. Males accounted for 54% of the referrals and females for 46%. Percutaneous renal biopsies were performed under ultrasound guidance on 167 patients or a rate of 17 procedures per year. Fifty-one patients, ranging in age from 0.5 to 19 years, were followed for end-stage renal disease during the 10-year study period. Glomerular disorders accounted for 61% of the end-stage renal diseases and anatomic disorders for 39%. The yearly incidence of end-stage renal diseases over this time was 9.8 patients/million children. Twenty-six (51%) of these patients received one or more kidney transplants during the study period.