Hyperuricemia is a common problem among renal transplant recipients. Its prevalence is clearly attributable to cyclosporine (CsA) use, although individual patients may have other risk factors as well. CsA lowers the urinary clearance of uric acid. The specific mechanism for this is unknown, but may involve alteration in tubular transport. Hyperuricemia may add on to several other factors in contributing to progressive deterioration of graft function and ultimately graft loss. The therapy of hyperuricemia may be particularly challenging in transplant patients.