First thing to nail down is the number of nights you will be there. That will determine how many real days you have.
Personally, we'd take the train from Milan to Lake Como for a couple of just to get acclimated. Then head to Venice and after a few days there go to Florence. Wind up in Rome and fly home from there.
Try to plan on stays of at least three (or more) nights in each place. The reason for that is it always takes more time than one anticipates when changing locations, and that is simply time lost that can't be regained.
I realize this is very general, but without knowing your exact time frame and interest it's hard to be very specific.
With regard to renting a car, I'd try to avoid it as it is simply a big hassle and the trains work wonderfully well in Italy. If you must rent a car, you might want to reconsider renting a car right away. Take the train to the first destination and rent the car there the next day or when you are ready to leave. Jet lag (no matter how well handled), lack of sleep, not being familiar with the local road system, can all be a problem. There are some that are not bothered by any of those things. Others think they are ok but are really driving somewhat impaired without realizing it. And some folks are complete zombies and should never drive on the day they arrive.
Just something to think about.