Acute renal failure (ARF) has undergone many changes with advances both in diagnosis and therapy. A retrospective study covering three and a half years from June 1986 to December 1989 of adults admitted to Hospital of the University of Science Malaysia examined the various aspects of presentation of the syndrome, management and areas where improvement can be made. A total of 164 patients were included in the study. 61.6% were male and 38.4% were female. The mean age was 49.8 +/- 17.2 years with 70% of patients being more than 40 years old. The aetiologies of acute renal failure were analysed and discussed. The majority of the patients (80%) had non-oliguric acute renal failure. Oliguric acute renal failure patients have higher mortality and more frequently need dialysis. Early recognition of acute renal failure and discerning use of nephrotoxic drugs could result in decrease in incidence and severity of renal failure.