SUMMARY

A survey has been made of 251 cases of acute renal failure (acute tubular necrosis). The over-all mortality was 44 per cent. Despite increasing expertise in the manage-ment of this complication of surgical, medical, and obstetric disorders, considerable technical advances in dialysis, and increasing recognition and improved manage-ment of incipient renal failure, there was no decrease in mortality over the 11-year period of the survey. Four major factors have been identified as having an adverse influence on prognosis, namely age, infection, surgical gastrointestinal lesions, and gastrointestinal haemorrhage. Failure to improve the survival figures despite increasing experience in management is due to a shift in the spectrum of severity of the patients encountered, in that a larger number of older patients with more critical illnesses are being referred to renal-failure units. Although the acute renal failure may be controlled in the earlier stages of the illness, many of these patients die later of overwhelming infection or other complications