Background: Chronic allograft nephropathy (CAN) is a major cause of renal graft loss. Connective tissue growth factor (CTGF) expression is increased in fibrotic renal diseases including diabetic nephropathy and CAN. Objective: Assessing urinary CTGF as a non-invasive marker of CAN. Patients and method: Urinary CTGF was measured in samples collected from all the study candidates which included transplanted patients with normal kidney functions tests and estimated glomerular filtration rate(e GFR) more than 60 ml/minute as a control, transplanted patients with biopsy-proven diagnosis of IF/TA indicating presence of CAN, and e GFR between 30 -59 ml/minute and transplanted patients with biopsy-proven diagnosis of interstitial fibrosis (IF/TA), indicating presence of CAN, and e GFR less than 30 ml/minute. To assess the effect of the native kidneys, hemodialysis patients were recruited and their urine samples were collected and to measure CTGF. To adjust for decreasing GFR and urine output, urinary creatinine was measured in all samples, and CTGF/creatinine ratio was calculated. Results: The mean urinary CTGFin patients with CAN was significantly higher than the mean level in transplant candidates with normal kidney function.The mean urinary CTGF in patients with CAN and marked graft dysfunction was significantly higher than the mean level in those with milder graft dysfunction. The mean urinary CTGF was found to be significantly higher in patients with history of acute rejection than in those without history of acute rejection. There was a significant positive correlation between urinary CTGF level and both of serum creatinine and duration of transplantation, and a negative correlation between urinary CTGF level and e GFR. The CTGF/creatinine ratio showed similar results. Conclusion: Urinary CTGF level and CTGF/creatinine ratio could be used as an early non-invasive marker of chronic allograft nephropathy.