Chronic hemolytic anemia may be associated with a variety of renal manifestations ranging from minimal functional changes to chronic renal failure. These manifestations include hematuria, tubular dysfunction, glomerulopathy, renal failure and renal medullary carcinoma. Renal involvement commonly occurs in sickle cell disease and may be detected in thalassemia. The ideal therapeutic measures for these alterations are still being studied, so some preventive and supportive measures are required in management of these manifestations. Renal involvement may affect the management of chronic hemolytic anemia including diagnosis, management, prognosis and possible preventive measures.