OBJECTIVE: To examine the prevalence of glomerular disease in Hong Kong. DESIGN: Prospective review. SETTING: University teaching hospital, Hong Kong. PATIENTS: All patients who presented with suspected glomerular disease from 1993 through 1997. MAIN OUTCOME MEASURES: Histopathological diagnosis from biopsy examination and clinical features of presentation. RESULTS: A total of 1629 consecutive percutaneous renal biopsies of native kidneys showed glomerular disease in 1413 cases. The most common clinical indication for renal biopsy was persistent proteinuria (n=735; 52.0%), while the most frequently found glomerular lesion was immunoglobulin A nephropathy (n=338; 23.9%). Minimal-change nephrotic syndrome (n=125; 8.8%) and immunoglobulin M nephropathy (n=11; 0.8%), were the most common glomerular diseases that presented with nephrotic syndrome. The male to female ratio for lupus nephritis was 1:14 (n=290), whereas for minimal-change nephrotic syndrome, the ratio was 1.8:1 (n=125). Immunoglobulin A nephropathy and membranous glomerulonephritis (n=117) affected approximately equal numbers of male and female patients. Familial fibrillary glomerulonephritis, a disease hitherto unknown in Hong Kong, was diagnosed in two siblings. CONCLUSION: Immunoglobulin A nephropathy was the most common glomerular disease in this survey and represents an important cause of end-stage renal failure in the Hong Kong population.