Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease. In developing countries like Pakistan, many effusions remain undiagnosed after pleural fluid analysis and patients are empirically treated with anti-tubercular therapy. Objective: To determine the frequency of uremic and tuberculosis pleuritis in patients with advanced renal disease. Study Design: Cross-sectional study Study Duration: The study was conducted within 6 months after approval of synopsis i.e. from 2nd December, 2020 till 1st June, 2021. Methodology:150 patients who fulfilled the inclusion criteria were enrolled Informed consent was taken from each patient. Demographic information (name, age, sex, BMI and duration of renal disease) was noted. Then diagnostic pleural tap was done and exudates sample was taken. All exudative samples were further assessed by pleural 2 biopsy and sample was sent to the laboratory of the hospital for histological assessment of uremic or tuberculous pleuritis Results: The mean age (in years), BMI (kg/m2) and duration of disease (in months) of the patients was 39.5±14.2, 27.6±4.19 and 35.8±14.6. There were 55.3% males and 44.7% females. Uremic pleuritis was present in 69.4% and tuberculous pleuritis was seen in 30.6% patients. Age, gender and duration of disease was significantly associated with uremic and tuberculous pleuritis as indicated by a p value of 0.026, 0.048 and 0.007 respectively. Conclusion:Uremic pleuritis was more frequently seen as compared to tuberculous pleuritis in patients with advanced renal disease.