In a restrospective study of 220 patients with melioidosis admitted to the hospital over a period of 3.5 years, acute renal failure was noted in 77 patients. Interesting clinical features included hypercatabolism, hypoalbuminemia, hyponatremia, jaundice and multisystem involvement. Prognosis was poor especially when associated with jaundice, lung involvement and the presence of underlying diseases. Mortality rate was 89.6%. Renal failure is believed to the due to renal ischemia from multiple nonspecific factors. In a limited pathological study renal changes consisted of tubular necrosis, microabscesses, interstitial nephritis and mild tubular degeneration.