Chronic kidney disease is common, is expensive to treat and causes suffering and early death. In the 1990's, our government determined the number of people with kidney disease by blood and urine tests in a group of volunteers representative of the U.S. population. As many as 20 million people have some kidney disease, although most do not yet have symptoms. Once kidneys fail, the only treatment options are dialysis or transplantation. Nearly 100,000 people start dialysis or receive a transplant each year, which is greater than the number of patients who are diagnosed with breast or colon cancer. The cost to treat all transplant and dialysis patients exceeds the entire National Institutes of Health yearly budget. Families of patients who need dialysis often become poor because of health care costs not covered by insurance. Chronic kidney disease has emerged as a silent epidemic. Investigators in the Kidney Diseases Center of Excellence seek to understanding clinical, cellular and genetic basis of kidney disease and to identify new ways to treat patients.