Despite the availability of improved medical therapy to slow the progression of nephropathy, a worldwide epidemic of end-stage renal disease (ESRD) exists. Many patients are not diagnosed until the late stages of disease, as early kidney disease may be asymptomatic. Ideally all adults would be routinely screened for evidence of early kidney disease and associated risk factors such as hypertension and diabetes mellitus. Unfortunately this would be a massive and expensive undertaking. A more practical, cost-effective solution might be to direct screening at those individuals who are known to be at high risk for the development of nephropathy. The familial clustering of ESRD has been reported for many types of renal disease. We propose that the routine screening of first- and second-degree relatives of ESRD patients for nephropathy might be an efficient way to detect subclinical renal disease. Early detection and intensive treatment of renal disease may help to curb the current epidemic of ESRD.