During a 36-month period from 1992 to 1994, 33 patients with severe polytrauma acquired in war combat (1 female, 32 male, 38.61±8.79 years) developed acute renal failure (ARF) which required hemodialysis (HD) treatment. In 12 patients, multiple system organ failure (MSOF) occurred as a complication of either general conditions or septic complications. In 17 patients (51.4%), and in 3 patients with MSOF, recovery of renal function occurred. We compared the outcome of ARF and several predictive scores (APACHE II and ATNISS). The APACHE II score did not correlate with the outcome of ARF, and ATNISS significantly correlated with the outcome of ARF. The maximum value of ATNISS in the patients with lethal outcome was 1.004, and the minimal value with the same outcome was 0.182. Although ATNISS is a very good score of severity, it seems to underestimate very influential factors in patients with severe polytrauma with ARF (MSOF, mechanism of trauma).