This review focus on the natural history of chronic renal disease associated with hypertension and will discuss separately the renal disease hypertensive emergencies, hypertension in association with preexisting renal disease and mild hypertension in patients with normal kidneys. Chronic renal disease results in profound lipid disorders, which derive largely from dysregulation of HDL and trygliceride-rich lipoprotein metabolism. A specific mention of is made of patients with a deficiency of LCAT and patients with abnormal variants of Apo E in relation to the lipid-induced chronic renal damage. We discuss the pathogenetic mechanisms involved in the hypertension-induced and dyslipidemia-induced renal damage and the hypertension and lipid disorders resulting from renal disease.