Introduction: Renal Failure Represents Approximately 1% Of Emergency Admissions. In Our Setting, The Vast Majority of Chronic Renal Failure Patients Are Under-Dialyzed, And Access to Emergency Extracorporeal Renal Replacement Therapy Is Not Always Available. Objective: To Report the Clinical, Therapeutic, And Evolutionary Characteristics of Renal Failure in the Emergency Department of A Tertiary Hospital in Africa. Patients And Methods: This was a Cross-Sectional Prospective Study from January to December 2024, Including All Patients Presenting with Renal Failure Either at Admission or During Management of Another Condition in The Emergency Department. Results: During The Study Period, 160 Patients Were Diagnosed with Renal Failure, Giving A Prevalence Of 3.55%. The Mean Age Was 50 Years [16,7]. There Was A Male Predominance Of 54.4%. The Main Reasons for Consultation Were: Respiratory Distress 24.38%; Altered Consciousness 23.75%; Infectious Syndrome 12.50%; Arteriovenous Fistula Rupture 5%; Deep Vein Thrombosis 3.13%. A Total Of 33.1% Of Patients Were Known Chronic Renal Failure Patients, and 23% Were on Chronic Dialysis. In Addition, 29.4% Of Patients Were Diabetic, And 59.4% Hypertensive. A History of Nephrotoxic Drug Intake Within the Three Months Prior To Admission Was Found In 30.6% Of Patients. At Admission, 40% Had A GCS < 15; Mean Spo₂ Was 89% [8.4]; Mean MAP Was 102 Mmhg. Mean Hemoglobin Level Was 8 G/Dl [2.5]; Creatinine 627 µmol/L [526]; Sodium 127 Mmol/L [10.46]. Life-Threatening Hyperkaliemia Was Present In 8.8% Of Patients. Oxygen Therapy Was Initiated In 55% Of Patients. Ten Percent Were Transfused. Emergency Renal Replacement Therapy Was Performed In 70% Of Cases. Major Complications Included: Infectious Pneumonia 25.6%; Uremic Coma 8.1%; Hemorrhagic Syndrome 5%; Status Epilepticus 2.6%. Mortality Was 31.3%. Mean Length of Stay Was 6 Days [3.5]. Conclusion: Under-Dialysis Is Responsible for Decompensations and High Mortality.