Acute renal failure in diabetic patients occurs, as a result of certain specific conditions. The most common of these are hyperglycaemic hyperosmolar ‘coma’, diabetic ketoacidosis, the use of radiocontrast media, and renal papillary necrosis. The management of diabetics with acute renal failure is essentially the same as for non-diabetic patients but may be complicated by the problems of metabolic control, vascular access, and vascular instability. Prevention is important as the development of acute renal failure adds considerably to the morbidity and mortality of these conditions and is often avoidable.