Trauma complicated by acute renal failure provides a challenge for the members of the critical care team. Clinicians face a wide range of clinical problems complicated by a climbing mortality rate, as high as 70%. To meet this challenge, clinicians need an understanding of the most recent studies, so they can determine whether the findings can be translated into practice. In addition, prevention needs to be made the frontline of care, and when this is not possible, the second consideration must be directed at selecting therapeutic modalities for the creation of a nonoliguric acute tubular necrosis. These efforts will assure that patients receive the most current and comprehensive care. This article supports these efforts by providing an explanation of the pathogenesis of acute tubular necrosis on a cellular level and interpreting this information on a renal structural level, as well as into the clinical practice by including a description of a variety of medical and nursing modalities as found in the literature.