Intravenous immune globulin (IVIG) therapy has been used more commonly to treat a number of clinical disorders. During the past 10 years, IVIG infusion has been associated with a variety of complications. Acute renal failure, which was not described in the initial drug trials, was recognized as an adverse effect of IVIG therapy in 1987. Since the original report, a number of cases have been described in the literature. Older age and preexisting renal impairment appear to predispose to the development of acute renal failure. Acute renal insufficiency develops within days and resolves over several days to weeks. However, in some cases, recovery is delayed and initiation of renal replacement therapy is required. Chronic renal insufficiency requiring maintenance dialysis is extremely rare. The precise cause of IVIG-associated acute renal failure is unknown but may be attributable to either the direct effects of the immunoglobulin or the stabilizing agent used in the IVIG preparation.