Pulsatile stress is defined as product of pulse pressure (PP) and heart rate (HR) and is largely regulated by arterial stiffness in general and specifically with reference to patients with renal insufficiency by sympathetic nerve activity. Direct effects of the pulsatile stress on heart, coronary system and ultimately cardiovascular survival have been documented whereas no data exist relating to renal transplant patients. We analysed the relation of macrocirculatory disturbance to microcirculatory defects in 92 renal transplant recipients. Therefore, we investigated aortic stiffness by carotid-femoral pulse wave velocity (PWV), pulsatile stress and albuminuria. Pulsatile stress, not PWV was associated with the extent of albuminuria (r = 0.29; P < 0.01 and r = 0.06; P = 0.6 respectively), which was confirmed in multivariate stepwise regression analysis (P = 0.008). Dividing the data in tertiles of pulsatile stress revealed an eightfold increased risk for microalbuminuria and 12.2-fold increased risk for macroalbuminuria comparing upper with lower tertile of pulsatile stress. Pulsatile stress, not PWV correlates with albuminuria and predicts the degree of albuminuria in renal transplant recipients. Therefore, pulsatile stress reflects an easy and cost-effective marker for renal microcirculatory defects in renal transplant patients.