Gallbladder toxin of the grass carp (Ctenopharyngodon idella) is a less well-known cause of acute renal failure. Three cases are reported and the diagnosis is primarily clinical. All our patients presented initially with gastrointestinal upset including nausea, vomiting, diarrhea, and abdominal fullness. These symptoms usually occurred with 10 min to 18 h after the ingestion the raw gallbladder of the grass carp. All our cases developed acute renal failure and in two of them toxic hepatitises were noted. An acute tubular necrosis was demonstrated on renal biopsy in one of our patients. The treatment is mainly supportive and two of them received hemodialysis. All three cases recovered, with normal renal and liver functions 2-4 weeks after the incident. A review of the cases previously reported in the English literature is presented.