This article discusses the epidemiology, recognition, screening, and management of six systemic diseases that commonly present with renal manifestations: diabetic nephropathy, lupus nephritis, congestive heart failure, HIV, liver disease, and dysproteinemias. Diabetic nephropathy remains the leading cause of end-stage renal disease in the United States. The outlook for patients who have lupus nephritis and HIV-associated nephropathy has improved in the last decade. Kidney disease is common in patients who have advanced liver disease, and creatinine-based methods do not provide an accurate estimation of renal function in this population. Dysproteinemias are associated with protean renal manifestations, and renal disease may be the presenting manifestation.