Renal transplant recipients are at an increased risk of developing certain neurologic problems. These problems differ from those encountered in recipients of other organs. Development of atherosclerosis is accelerated in renal transplant patients and results in an increased incidence of thromboembolic events. Immunosuppressive therapy predisposes to infection with opportunistic organisms, including reactivation of latent viruses and also is associated with an increased incidence of de novo neoplasia. The transplantation procedure may be complicated by a neuropathy and occasionally by distal spinal cord infarction. Some immunosuppressive agents have a direct adverse effect on the nervous system, particularly when toxic levels accumulate in the body. Uremia prior to, and if present after transplantation, has a toxic effect on the nervous system as well. The reasons for these problems are discussed. Awareness of these special problems in renal transplant patients will facilitate their prevention and diagnosis. A recommended diagnostic approach has been outlined. After the etiology has been established, treatment can be tailored to the individual patient.