Background: Patients infected with hepatitis C virus (HCV) frequently develop renal failure after liver transplantation. Objective: To describe renal histologic characteristics and concomitant clinical features in HCV-infected patients with end-stage cirrhosis. Design: Case series. Setting: Single-center liver transplant program in the United States. Patients: 30 patients who received liver transplants for HCV-induced cirrhosis. Intervention: Kidney biopsy during liver engraftment. Measurements: Clinical data and laboratory tests of renal function within 6 months before liver transplantation. Results: Twenty-five patients had immune-complex glomerulonephritis: membranoproliferative glomerulonephritis type 1 (n = 12), IgA nephropathy (n = 7), and mesangial glomerulonephritis (n = 6). Of these patients, 10 had normal serum creatinine levels, normal urinalysis results, and normal quantitative proteinuria. For 5 others, the only renal abnormality was an increased serum creatinine level. No patient had cryoglobulins in the blood or kidney. Limitations: This small observational study did not include patients with nonviral cirrhosis and did not document post-transplantation outcomes. Conclusions: Immune-complex glomerulonephritis was common in patients with end-stage HCV-induced cirrhosis and was often clinically silent. Its potential to cause renal failure after liver transplantation may be underappreciated. © 2006 American College of Physicians.