Nutritional support in the patient with acute renal failure is of great importance in lessening the degree of catabolism when energy demands are high and may also result in salutary metabolic effects. Overall treatment considerations in the posttraumatic or postsurgical patient with acute renal failure will be discussed, including fluid and electrolyte balance and energy and nutritional considerations. The application of the Giordano and Giovannetti principles to the field of parenteral nutritional support enables modifications of treatment programs of total parenteral nutrition to be applied to patients with acute renal failure. Utilizing an intravenous mixture of eight essential l-amino acids, hypertonic dextrose, and vitamins, we observed salutary biochemical effects in surgical patients. A prospective, randomized double-blind study of that treatment regimen compared to patients receiving hypertonic dextrose and vitamins alone resulted in improved survival and a decreased duration of renal failure in the treated group. Management considerations of these patients and possible application of these principles to other patients in renal failure will be discussed.