The prevalence of pancreatic disease was determined in 21 autopsied uremic patients who had died during the course of maintenance hemodialysis, as compared with 60 autopsied patients without kidney or pancreatic disease. Histologic criteria of pancreatic disease included. (1) duct ectasia; (2) periductal fibrosis; (3) ductular proliferation; (4) acinar ductalar metaplasia, and (5) interstitial inflammation or fibrosis. Significant pancreatic disease was present in 56% of the uremic patients and only 11.8% of the controls (p < 0.01). Two uremic patients had abscesses in the tail of the pancreas. The clinical significance of the high prevalence of pancreatic pathologic alterations in uremia remains to be assessed.