1. This study analyzed 2098 cases of acute renal failure (ARF) treated at Sindh Institute of Urology and Transplantation in Karachi, Pakistan between 1990-1999. 2. The most common causes of ARF were medical (45%), surgical (28%), and obstetrical (17%). Within medical causes, gastroenteritis (34%), nephrotoxins (14%), and malaria (13%) were leading factors. 3. Treatment was primarily hemodialysis (88%), with peritoneal dialysis (2%) and fluid therapy (10%) also used. Overall recovery rates were 60% for medical, 65% for surgical, and 42% for obstetrical AR