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We reviewed autopsy records from 20 patients with long-standing spinal cord injury and chronic renal failure. Only 1 patient had normal pulmonary findings at autopsy. Acute and chronic pulmonary diseases were found in 16/20 and 17/20 patients, respectively. Pneumonia and fluid overload were the most common acute diseases. Interstitial and pleural fibrosis were the most common chronic diseases. However, a variety of illnesses including pulmonary amyloidosis, calcification, and arteriosclerosis were also found. Arterial blood gas studies indicated a high prevalence of hypoxemia. We concluded that significant pulmonary abnormalities are present in almost all spinal cord injury-chronic renal failure patients