The development of perioperative acute renal failure is associated with a high incidence of morbidity and mortality. Although this incidence varies with different surgical procedures and with the definition used for renal failure, we now understand better the aetiology of the underlying problem.A priority for anesthesia care providers is to limit perioperative renal impairment. This process begins with the identification of patients at increased risk for perioperative renal dysfunction, understanding basic renal physiology and the influence of perioperative events and drugs on the pathophysiology of renal function.Several renal protection strategies have been investigated through the last decade to improve the renal outcome. At the present time, maintenance of adequate intravascular volume, mean arterial pressure as well as cardiac output are the most important renal protection measures under purview of the perioperative anesthesiologist.