Prerenal causes of acute renal failure occur as situations outside of the renal system that decrease pressure in the afferent arteriole and consequently restrict blood flow to the kidneys. Though compensatory measures help to maintain blood flow to the kidneys, an arterial pressure of less than 70 mm Hg causes most compensatory mechanisms to
fail. Cardiovascular disorders, low blood volume, drugs causing vasoconstriction or peripheral dilation, or obstruction to the renal vasculature such as clamping major arteries during surgery are some of the factors related to decreasing the blood flow to the kidneys. If blood flow is restored in time, damage caused by these situations is minimal.

Intrarenal factors cause damage to the renal tissue and nephrons of the kidneys. The glomerulus may be the site of injury, such as with glomerulonephritis, but most commonly acute tubular necrosis is the cause of acute renal failure. Acute tubular necrosis can be caused by either prerenal or postrenal factors if they result in ischemia or nephrotoxic damage to the tubules. Nephrotoxic injury may be caused by aminoglycoside antibiotics or radiocontrast dyes. Hemoglobin released from damaged red blood cells (caused by mismatched blood transfusions) or myoglobin released from crushed muscle cells (rhabdomyolysis) combined in a series of events has a direct toxic effect, causing damage to the tubular cell.

Postrenal factors responsible for acute renal failure include damage that occurs to the structures located distal to the kidneys. An obstruction to urine flow, whether located in the bladder, ureters, or urethra, can result in a backflow of urine to the kidneys, causing an increase in interstitial pressure and ultimately in the nephron. Prostatic hyperplasia, calculi, tumors, or trauma are some of the problems that can cause an obstruction to these urological structures.