The use of diuretics in the acute care setting (intensive care units, operating rooms and emergency departments) is an area of significant clinical and laboratory research. These agents are frequently used to facilitate fluid management and in the hopes of protecting the kidneys from injury. The pros and cons of continuous infusion of loop diuretics, and albumin supplementation are discussed along with the issues related to their use to avoid dialysis or to improve outcome. In addition, the evidences is support of the use diuretics to prevent or treat acute failure in the acute care setting are reviewed and discussed.