Various reports in the literature have suggested an association between end-stage renal disease (ESRD) and acute pancreatitis. Little information concerning this association has been discussed in the radiological literature. In this report, the authors review their experience with 54 episodes of acute pancreatitis in 34 patients, including 26 treated with maintenance dialysis, six who underwent renal transplantation, and two managed conservatively before definitive therapy. Ten (29%) of these patients died. Thirty-one computed tomographic (CT) and 49 ultrasound (US) studies of 30 patients were reviewed and demonstrated findings ranging from normal anatomy to fulminant necrotizing pancreatitis. Fifteen US examinations were technically inadequate for evaluation of the pancreas. None of the CT scans were technically inadequate. The authors emphasize the need for increased awareness of ESRD as a possible risk factor for the development of acute pancreatitis.