Coexistence of hypertension and kidney disease is very common. Renal parenchymal disease, which includes a wide spectrum of acute and chronic renal disease, represents the most frequent form of secondary hypertension, accounting for over 5% of cases referred to a hypertension center for evaluation. Underlying morphologic renal lesions and severity of renal functional impairment determine the range and degree of blood pressure elevation. Hypertension is more frequent and more severe in glomerular than in tubulointerstitial nephritides. Further, the prevalence rates of hypertension are highest in membranoproliferative glomerulonephritis. Blood pressure elevation is minimal in minimal change nephropathy (lipoid nephrosis). Hypertension is frequent also in nephrolithiasis, diabetes, renovascular nephropathy, embolic renal disease, pregnancy, renal replacement therapy and drugs. Hypertension may subside with resolution of renal disease or may persist.