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Information from a variety of research and clinical methods related to the morphology and function of the renal vascular bed has been synthesized to analyze the role of the renal angiogram in the diagnosis of parenchymal disease of the kidney. With few exceptions, it is clear that the arterial tree of the kidney responds in a limited manner to a variety of diseases. Thus there is little basis for using the individual vascular elements of the arteriogram to make specific pathologic diagnoses. On the other hand, careful analysis of the angiographie nephrogram may allow individual cases to be classified according to perfusion abnormalities which may be of diagnostic and prognostic significance. Vascular changes produced by aging alone parallel those produced by diseases and must be taken into account in the analysis of die renal angiogram.