Background: Adequate assessment of fluid status is an imperative objective in the management of HD patients. An inaccurate assessment of dry weight leads to many complications. Objective: The aim was to assess applicability of clinical using inferior vena cava (IVC) and lung ultrasonography to assess dry weight and the adequacy of fluid removal in hemodialysis children with special relation between acute and chronic renal failure. Patients and methods: 75 children were classified into two groups: Group (1): Chronic renal failure and group (2): Acute renal failure. Results: A statistically positive significant correlation between percent of weight loss after dialysis among the studied patients and all of serum ferritin, creatinine, phosphorus and iron. There was statistically negative significant correlation between percent of weight loss after dialysis among the studied patients and serum creatinine. There was statistically significant negative correlation between percent of weight loss after dialysis among the studied patients and SPAP. There was statistically non-significant correlation between percent of weight loss after dialysis among the studied patients and percent change in IVC inspiratory diameter, expiratory diameter, collapse index and B lines. There was statistically significant difference between the studied groups and expiratory IVCD, collapse index before and after dialysis, difference in B lines. Conclusion: Lung ultrasound is an accurate and sensitive method of quantifying subclinical fluid overload in children on dialysis before its clinical manifestation. IVC measurement is reliable to assess intravascular fluid overload in children on HD and was not correlated with extracellular fluid volume as need more time (2-3h) after dialysis and maneuver difficult with young age.