A case/control study of occupational and other exposures associated with male end stage renal disease (ESRD) was conducted. The cohort consisted of 375 males, 30 to 69 years old, who were diagnosed with ESRD between 1976 and 1984 and who lived in four urban areas in Michigan. The cases were identified from the Michigan Kidney Registry. The referents consisted of 325 randomly selected males matched to the cohort by age, race, and area of residence. Telephone interviews were conducted with 69% of the cases and 79% of the referents to obtain information on medical and occupational histories, use of drugs, family history of kidney disease, consumption of alcohol and moonshine, and demographic characteristics. Occupational exposures were assessed from the occupational history data. Odds ratios (ORs) for ESRD were computed. ORs for ESRD were significantly elevated for use of phenacetin (62442) or acetaminophen (103902), moonshine consumption, familial history of kidney disease, and regular exposure to organic solvents or silica (14808607). The OR for ESRD was nonsignificantly associated with duration and use of phenacetin and acetaminophen. ORs were significantly associated with organic solvents used as degreasers and silica used in foundries or in sandblasting. Occupational exposure to lead (7439921) was nonsignificantly associated with an increased risk for ESRD. Most subjects exposed to degreasing solvents were employed in metal manufacturing industries. Except for silica used in sandblasting the risk of ESRD was not associated with duration of exposure. The OR for 2.5 years exposure to silica for 40 hours a week was 2.74. The authors conclude that although the study has several limitations, a number of associations have been observed that warrant further investigation.