We analysed 110 adult patients with cerebral malaria, 38 of whom had serum creatinine above 3 mg%, to study the effect of acute renal failure (ARF) on survival. Patients with cerebral malaria had an increased risk of death (39.5% versus 13.9%) when also suffering from ARF. For each one log unit increase of creatinine at admission, odds of death increased by a factor of 10.8 (95% confidence interval 3.0-39.4).