AVARIETY of endocrine and metabolic abnormalities are associated with end stage renal disease (1, 2). These disorders can occur despite effective dialysis and adequate biochemical control and respond only to successful transplantation. Since uremic endocrinopathies interfere with the patient's quality of life and rehabilitation potential and, in some instances, may affect adversely long term survival (3), information about their pathogenesis is of prime practical importance. This article discusses the pathogenetic mechanisms of endocrine disorders in uremia, listing examples of specific hormonal changes associated with each alteration. The reader is also referred to recent reviews where endocrine changes in renal disease are listed separately for each hormone (1, 2). Endocrine disorders result either from altered concentrations of active hormone arriving at the target tissue, or from aberrant responses of the end organ to appropriate hormonal levels. In principle, this pathogenetic classification also holds true for the endocrine abnormalities seen in the uremic syndrome (Table 1), although frequently a combination of factors is operative in this condition.