Among the greatest achievements in medicine is the eradication or control of many infectious diseases following the development of highly effective vaccines. To achieve such prevention it is of course imperative that all children complete the recommended series of immunizations and this includes children who have intercurrent illnesses. If such illnesses are associated with known or suspected suppression in immunocompetence, for a variety of appropriate reasons, physicians have often been reluctant to administer vaccines. This is unfortunate since patients with altered immune function axe even more vulnerable to the severe manifestations of common infectious diseases. The present communication summarizes recommendations of the Committee on Infectious Diseases of the American Academy of Pediatrics , the Advisory Committee on Immunization Practices (ACIP) , and the Canadian Paediatric Society  relevant to the use of vaccines and immune globulins in children with renal disease and altered immunocompetence. The present recommendations also take into consideration recent publications on vaccine efficacy as well as our current understanding of immune function during renal failure and in children with nephrotic syndrome.