The last several years have seen extensive study of the treatment of acute anuria, which has been summarized in thoughtful1-3 and comprehensive 4 reviews. At the same time the technical aspects of hemodialysis have been refined and simplified to a point where the artificial kidney is applied in many centers routinely without significant morbidity or intolerance of the procedure.5-9 The initial scepticism concerning the beneficial aspects of this treatment 11-16 has been supplanted by a recognition of its life-saving potentialities by ever-widening circles of clinicians.4,9,17-22 In view of the widespread interest in the artificial kidney it is surprising that agreement concerning the indications for it was in individual patients with acute anuria is lacking and that, indeed, indications for dialysis are entirely omitted in a recent review.1 Are the signs and symptoms which form the clinical indication for use of the artificial kidney so elusive and