The appalling mortality of acute renal failure in casualties in the Second World War has been reduced considerably by a better understanding of the clinical manifestations and improved therapeutic techniques which include early dialysis, better resuscitation measures, and maintenance of high urine flows in the high risk patients. The role of nephrotoxic antibiotics and other nephrotoxins especially radiographic contrast media, is increasing in importance. Non-oliguric acute renal failure is now a well documented clinical entity and although the mechanisms responsible for acute renal failure are still far from settled, the spectrum of acute renal failure in terms of clinical setting, predisposing factors and clinical features have changed since acute renal failure was first described.