Recovery from acute renal failure after 11 months of hemodialysis

A 46-year-old man with biopsy-proved acute tubular necrosis made a dramatic recovery after remaining oliguric and requiring maintenance hemodialysis for 11 months. The serum creatinine level declined to 5.8 mg/dL and, as hemodialysis was discontinued, a second renal biopsy showed marked regenerative changes in the renal tubules. This delayed and unexpected improvement in renal function underscores the need to avoid early renal transplantation in the patient with protracted renal failure from acute tubular necrosis.