Thirty per cent of 50 consecutive patients with end stage renal disease were found to have vesicoureteral reflux. This finding is at variance with the usually published etiologies of end stage renal disease. Forty per cent of the patients with reflux had no history to suggest the presence of this entity. The clinical importance of reflux in the post-transplant period as well as its possible etiologic role in end stage renal disease is discussed.