Nitric oxide has been recognized as an important paracrine or autocrine system during the past decade. The generalized importance of this rather simple molecule has been demonstrated in of a variety of neural, epithelial, vascular and immune systems. The degree to which alterations in nitric oxide metabolism contribute to the physiologic and pathophysiologic status of patients with end-stage renal disease remains to be fully defined in both experimental animals and in humans afflicted with renal disease.