To uncover the pathological feature of delayed renal graft function (DGF) and to explore corresponding prevention and treatments, 84 recipients receiving renal biopsy in our center from December 2007 to September 2010 were enrolled in this study, and 32 cases belonged to DGF. B-type ultrasonography-guided renal needle biopsy with BARD (a company in USA) biopsy needle was performed. After H and E staining, histochemical staining and C4d immunohistochemical staining, pathological types of all biopsy specimens were identified based on Banff'05 standard. DGF was finally confirmed based on the pathologic state of renal graft, and meanwhile clinical data, treatments and curative effects of each patient were recorded and analyzed. After renal biopsy, all patients must be in supine position for 8 h, and anti-inflammatory treatment and hematischesis was given. The main cause of DGF was acute tubular necrosis (ATN) in 20 cases, acute rejection (AR) in 8 cases and nephrotoxicity of immunosuppressants in 4 cases, 31 cases received hemodialysis, and one case received surgical removal. After timely treatments, renal function gradually restored normal in 28 cases, serum creatinine was between 135 to 300 μmol/L in 3 cases, and renal graft was finally removed in one case due to AR. DGF is a common postoperative complication of kidney transplantation, with high incidence. ATN and AR are the main etiological factors of DGF. The appropriate style and timely performance of plasma exchange is crucial for the prognosis of DGF. Other complementary treatments are also conducive to the restoration of renal function. The majority of DGF can gradually recover by plasma exchange in combination with complementary treatments. © 2011 Academic Journals.