Although acute renal failure (ARF) remains an uncommon problem in pediatrics, it is characterized by significant morbidity and mortality. This review addresses several broad topics related to ARF and summarizes the results of recent studies of particular significance. Following a brief discussion of the main causes of ARF in children, more detailed attention is paid to the problems of ARF caused by hemolytic-uremic syndrome and of ARF in neonates. Management of ARF is reviewed, including recent advances in dialysis modalities. Recent data on the outcome of ARF in children are summarized, and future approaches to the prevention and management of ARF are briefly examined.