In 1990, the National Kidney and Urologic Diseases Advisory Board published a long-range plan entitled ''Window on the 21st Century.'' In that plan, the board recommended that Congress establish a new National Institute of Kidney and Urologic Diseases (NIKUD). This recommendation stemmed from the board's appreciation that patient morbidity and mortality from kidney and urologic diseases continue to increase and that a focused, well-funded research endeavor is the only real hope for reversing this trend. In 1992, the board established a special subcommittee to further consider the establishment of a NIKUD. The subcommittee sought input from a wide variety of extramural and intramural sources. American Urologic Association - a new devoted institute would provide coordination and expansion of basic research into kidney and urologic diseases, now fragmented and underfunded within multiple institutes. The research areas of kidney and urologic diseases are not currently receiving adequate or appropriate attention proportionate to their prevalence and their adverse impact upon society. The American Society of Nephrology (ASN) supports the establishment of a separate kidney and urology institute. First and foremost, our primary interest is to obtain more support for kidney and urologic diseases. Such research does not receive the emphasis and prominence that it deserves at the National Institutes of Health. ASN believes that a separate institute would provide increased focus for these diseases. National Kidney Foundation (NKF) - the creation of such an institute is the highest priority of the medical and lay constituencies of the NKF. American Foundation for Urological Disease - the creation of a new (kidney and urology) institute within the National Institutes of Health is by far the most expeditious way to centralize and advance the research efforts in this critical field. Scope of a new NIKUD - NIKUD should develop an intramural and extramural research program that focuses on all aspects of kidney and urology diseases. NIKUD should be organized so that its activities address issues in both pediatric and adult kidney and urologic diseases, including renal failure, transplantation, hypertension, diabetes, cancer, incontinence, sexual dysfunction, and male reproduction. NIKUD must foster research training and career development.