Occupational and environmental exposures contribute to the development and progression of chronic kidney disease (CKD) With the current epidemic of chronic kidney disease, internists should be aware of the role of occupational and environmental exposures contributing to CKD, the mechanism of injury, and the best approaches to diagnosis and treatment. A thorough occupational history is a critical part of any evaluation of kidney disease when doing a history and physical. This article will review which occupations and environmental factors put patients at risk, and discuss management strategies.