Sixty two children aged 12 years or below, with chronic renal failure (CRF) were admitted to Asir Central Hospital, Saudi Arabia, in the period from June 1990 to June 1995. Of them, 39 (63%) were in CRF while 23 (37%) were in end-stage renal failure (ESRF) at the time of presentation giving a mean annual incidence for CRF of 15.6 and for ESRF of 9.2 per million children. The male to female ratio was 1.8:1. The mean age of the children was 5.5 years (age range 20 days to 12 years). Urinary system anomalies (including urinary tract anomalies) were the leading cause of CRF (64.5%) followed by gloraerulopathies (17.7%). In those who presented before the age of six years, SO.9% had CRF caused by urinary system anomalies (including inherited kidney anomalies such as polycystic disease) while such anomalies accounted for only 30% of CRF in children older than six years. Glomerulopathies were the leading cause (45%) of CRF in this latter group. We conclude that our mean annual incidence of CRF and ESRF is high and urinary system anomalies constitute the commonest cause among children in our region. Early diagnosis should therefore be encouraged to ensure early treatment of these anomalies, thus decreasing the incidence of CRF.