The Dialysis Centre at the Lagos University Teaching Hospital was established in November 1981 as the first unit in West Africa to undertake chronic hemodialysis treatment. More than 500 patients have been managed in the center since then. Of these, 175 were cases of acute renal failure. The causes and outcome of these cases have been reviewed. There were 89 males (50.9%) and 86 females (49.1%). The majority, 111 (63.4%), were aged < 40 years. The main cause was sepsis, which occurred in 67 cases (38.3%). Gynecological and obstetric cases were 45 (25.7%), including 14 cases (8%) of pregnancy toxemia. Other causes were hemorrhage 18 (10.3%), obstructive uropathy 6 (3.4%), acute glomerulonephritis 8 (4.6%), and poisoning with "Holy Water" 6 (3.4%) and other nephrotoxins 9 (5.1%). Sixty-nine patients (39.4%) died in hospital, 92 (52.6%) recovered, and the fate of 14 (8%) was unknown as they were transferred from the hospital. Reasons for the high mortality included delayed hospitalization, selection of severe cases, and inability of patients to afford more than only one session of dialysis even though they needed more. It is hoped that as awareness of the value of dialysis increases and early treatment can be sought, the overall mortality will be reduced.