The increasing understanding of the molecular and cellular basis of acute renal failure and the development of cell culture methodology to grow differentiated cells in engineered structures provide substantial promise for new therapeutic derivatives to treat patients with acute renal failure (Table 3). The use of disintegrins to ameliorate intratubular obstruction, the administration of ANF to improve glomerular filtration, or the injection of growth factors to speed re-epithelialization may prove effective in altering the natural history of this severe clinical disorder. Furthermore, the development of cell therapy with a renal tubule replacement device may add critical renal functional components not currently substituted with dialysis or hemofiltration. The potential therapeutic advances which may occur as we enter the next century to treat this devastating clinical disease process have substantial promise.