Newborns at risk for acute renal failure require immediate diagnosis and treatment. Supportive care must be provided while the kidney heals and begins functioning again. The critical care nurse plays a vital role in early recognition and treatment of signs and symptoms of acute renal failure. As technology improves, a greater number of acutely ill newborns are surviving. The critical care nurse is managing more neonates with acute renal failure. Expertise in caring for these infants has also improved. Quality nursing care plays a crucial role in preventing complications and improving the prognosis of neonates with renal failure.