Four patients with end-stage renal failure (suspected to be) caused by cholesterol crystal emboli are described. Although cholesterol crystal embolization is generally considered to be fatal specifically when it is associated with renal failure, all four patients survived and in three renal function improved after periods of 3 weeks to 14 months of hemo- or peritoneal dialysis. The literature on cholesterol crystal embolization is reviewed and possible mechanisms of (partial) recovery of renal function are discussed.