Gender differences exist in hypertension, the prevalence of several renal diseases, progression of established renal disease, and within the ESRD program, including renal transplantation. Sex hormones play key roles in the pathogenesis and outcome of disease processes. Observational data suggest gender differences in the prevalence and outcome of several renal diseases. The molecular mechanisms associated with physiologic phenomena needed to explain gender differences in renal disorders, however, remain largely obscure. The interaction of psychosocial, economic, medical, and genetic differences associated with discrepancies between the genders in the process of receiving a renal transplant and sustaining graft function are currently unclear. Additional studies are needed in these and other areas to explain gender differences in the incidence, prevalence, and outcome of renal disease.