Metallothionein, a low molecular weight cadmium-binding protein, has been determined for the first time in urine of "itai-itai" disease patients and other Japanese women environmentally exposed to cadmium. On a group basis, the urinary metallothionein levels of "itai-itai" disease patients and suspected patients were significantly higher than that of women living in a cadmium-polluted area. Women living in a non-polluted area excreted significantly less metallothionein than women living in a cadmium-polluted area. A similar trend was observed for urinary beta 2-microglobulin, a nonspecific index of renal tubular dysfunction. However, mean levels of urinary cadmium in the "itai-itai" disease patients, suspected patients and women living in the cadmium-polluted area were similar. It is suggested that if, in addition to beta 2-microglobulin and cadmium, metallothionein is used as another index of cadmium exposure, monitoring of renal tubular dysfunction caused by cadmium may be more effectively carried out.