Chronic hepatitis C (HCV) infection may be associated with membranoproliferative glomerulonephritis (MPGN) with or without concomitant cryoglobulinemia. We report on a patient with end-stage renal disease caused by MPGN I in association with replicative HCV infection. Two years after successful renal transplantation, this patient developed nephrotic syndrome caused by recurrence of MPGN I in the renal transplant. The recurrence of renal disease after transplantation in this patient with chronic replicative HCV further elucidates the role of the viral infection in the pathogenesis of MPGN and suggests anti-viral treatment as, e.g., with interferon.