Renal transplant dysfunction poses a diagnostic dilemma. Clinical evaluation frequently is inaccurate and needle biopsy carries a significant risk of bleeding. Fine needle aspiration biopsy (FNAB) being an easy to perform, a less traumatic, and rapid technique, was employed in 22 cases of clinically suspected renal allograft rejection. The results were described as nil rejection, mild and severe acute rejection, chronic rejection and cyclosporin nephrotoxicity. Seven of these cases were also needle biopsied. Histology confirmed the cytology findings in all. However, an additional finding of acute vascular episode was observed in a case of chronic rejection. Fine needle aspiration biopsy diagnosis helped in altering the immunosuppressive therapy in 16 graft rejections (excluding 2 cases of irreversible rejection) and 2 cases of cyclosporin toxicity. No rejection was found in 2 cases. Thus, 20 renal grafts could be brought back to normal function. Negligible incidence of complication viz. microscopic haematuria of short duration was noted in only 1 case.