Although acute renal failure is common in patients with fulminant hepatitis, it has been recognized as a rare complication of non-fulrninant acute hepatitis A. So far about 30 patients have been described in the literature who had acute hepatitis A associated with acute renal failure. Variable renal biopsy findings have been described in previous reports, including mostly acute tubular necrosis, mesangial proliferative glomerulonephritis, and interstitial nephritis. But the exact mechanism by which hepatitis A causes acute renal damage is still obscure. We describe two cases with acute hepatitis A, proven by IgM anti-hepatitis A antibodies compli- cated by acute renal failure. One patient required hemodialysis. Kidney biopsy findings showed interstitial nephritis with no evidence of glomerular involvement. Our review of these cases and the relevant literature suggests that there is strong evidence to implicate hepatitis A virus as a cause of acute renal failure. It remains to be elucidated why the histologic features are variable in the cases of hepatitis A virus induced acute renal failure and which factors predispose a patients to have immunologic involvement versus interstitial and tubular involvement.