Acute renal failure by acute tubular necrosis. In adults, acute tubular necrosis is the leading cause of acute kidney injury (AKI). Secondary to ischemia and/or tubular toxicity, the commonly found histological lesions are desquamation of tubular epithelial cells and hyaline intra-tubular deposits. AKI is frequently observed with a non-altered urine output and associated with a proteinuria less than 1.5 g/24h without albuminuria, hematuria or leucocyturia. The association of an evocative clinical context and a spontaneous improvement of the AKI confirmed the diagnosis of acute tubular necrosis. The prognosis mimics that of the AKI and is often severe. Despite a functional recovery, the cellular repair is abnormal. This "maladaptive repair" phenomenon leads to accelerated renal aging and increase the susceptibility to nephrotoxicity. Consequently, the risk of chronic kidney disease becomes more important. Actually, no specific treatment of the acute tubular necrosis exists, however, because the "maladaptive repair" phenomenon, for patients exposed to more severe acute tubular necrosis, including those that have functionally recovered, a regular monitoring of renal function associated with simple nephroprotection's measures are recommended over the course of AKI.