Direct tissue analysis using matrix-assisted laser desorption ionization mass spectrometry (MALDI MS) provides in situ molecular analysis of a wide variety of biological molecules including xenobiotics. This technology allows measurement of these species in their native biological environment without the use of target-specific reagents such as antibodies. It can be used to profile discrete cellular regions and obtain region-specific images, providing information on the relative abundance and spatial distribution of proteins, peptides, lipids, and drugs. In this article, we report the sample preparation, MS data acquisition and analysis, and protein identification methodologies used in our laboratory for profiling/imaging MS and how this has been applied to kidney disease and toxicity.