【Abstract】 Objective To evaluate importance of pathologic assay in diagnosis of viral hepatitis in patients with end stage renal disease (ESRD). Methods Eighty-four ESRD patients with hepatitis B or C virus infection were received the percutaneous liver biopsy. The severity of liver inflammation and fibrosis was evaluated by semi-quantity technique. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), and prothrombin activity (PTA) were detected. The correlation between the clinical feature, parameters of blood biochemical test and the liver histopathological data were studied. Results Necroinflammatory activity was significantly associated with the severity of fibrosis (P<0.01). Clinical diagnosis of hepatitis was in accordance with the histological evaluation in 32 cases (38.1%). There is no significant difference in serum levels of ALT, AST, TBIL, ALB and PTA between patients with different severity of liver inflammation and/or fibrosis. Conclusion Liver biopsy is the only reliable method of confirming the presence and assessing the severity of liver disease in patients with ESRD.