Objective To study the clinical characteristics, manifestations, mortality, lethal causes and prognosis of mannitol (MT)-induced acute renal failure (ARF). Methods We retrospectively analyzed the data of 1234 MT-induced ARF cases published in mainland China in 81 literatures during the period of 1980 to 2002. Results ① In 5981 cases treated with MT, the incidence of MT-induced ARF was 6.73%. The average age of MT-induced ARF cases was 60.85±10.38 years. In 76.19% of MT-induced ARF cases, the primary diseases were cerebral hemorrhage and cerebral infarction. ② In MT-induced ARF cases, the average daily dosage and cumulative dosage of MT were 253.82±42.46g and 1034.37±104.82g, respectively. ③ Oliguria was found in 80%, and hematuria in 50% of the patients. ④ The mortality rate of MT-induced ARF was 26.15%, and the main causes leading to death were multi-organ function failure (41.07%) and cerebral hernia (28.57%). ⑤ The mortality rate was 45.31% in patients treated with MT more than 200g daily, much higher than the rate of 10.87% in those used MT less than 200g daily. ⑥ The mortality rate was 17.01% in MT-induced ARF patients treated with dialysis. In contrast, the rate was 26.69% in those without dialysis. Conclusions ① Factors prone to MT-induced ARF are age of more than 60, cerebral hemorrhage and cerebral infarction. ② The principal manifestations of MT-induced ARF are oliguria and hematuria. ③ The mortality rate of MT-induced ARF was 26.15%, and multi-organ function failure and cerebral hernia are the two main causes leading to death. ④ The mortality rate increases in patients treated with mannitol more than 200g daily. Dialysis is useful in improving their prognosis.