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Clinical study was made on 65 cases of acute renal insufficiency experienced at the Department of Urology, Kyoto University from 1962 to 1969. 1) Causes and clinical manifestations of acute renal insuffiCiency were varied, but they were classified into the prerenal origin (32 cases), the renal origin (23 cases) and postrenal origin (10 cases). 2) Main treatment for these cases was dialysis. Forty-four (67.7 %) received hemodialysis with either Kolff's twin coil artificial kidney or Kiil two layers dialyzer. Twenty (30.8 %) were treated by peritoneal dialysis. 3) As to prognosis, over-all mortality was 44.6 % (29/65). Although the mortality rate was quite high (60 %) for the first few years, it has decreased to 40 % for the recent two years probably because of adoption of the early and preventive hemodialysis which has been technologically improving. Mortality rate of each causative origin was as follows: prerenal 53.1 % (17/32), renal 39.1% (9/23) and postrenal 30% (3/10). Prognosis of the group of prerenal origin was therefore poor, in which mortality rate of hepatorenal syndrome was 100 %, postoperative 50 % and posttraumatic 40 %. Adult age groups, 31 to 60 years, showed relatively high mortality. 4) Complications observed were cardiovascular disorder, pulmonary edema, and hemorrhage. This order is that of frequency as well as that of cause of death. 5) Pathophysiological aspect of the development of acute renal insufficiency was discussed with emphasis on intrarenal circulation at the time of acute renal failure. Mechanism of oliguria and anuria was also discussed from both of glomerular and tubular function.