Uric acid nephropathy is a potentially reversible cause of acute renal failure resulting from diffuse urate crystal depositions in the tubules in the setting of excessive uricosuria. Hyperuricemia is frequently encountered in ICU patients with acute renal failure of any etiology, but it is rarely a prominent feature or a major pathophysiological element in the renal failures of nonhematology/ oncology patients. It can, nevertheless, be severe in some pathologies associated with massive tissue destruction such as rhabdomyolysis. The most frequent clinical context is, nevertheless, hematological, when patients with large tumor burden and rapid cell turnover develop acute tumor lysis syndrome (ATLS). The purpose of this chapter is to review the pharmacological tools currently available and their optimal use in the treatment of patients admitted in intensive care unit with hyperuricemia and severe acute renal failure.