Approximately 5% of the population has renal disease, with a trend toward increasing prevalence with age. Perioperative renal dysfunction complicates patient management and results in increased morbidity and mortality. Aside from optimizing intravascular volume status, there is no definite consensus on prophylaxis for the development of acute kidney injury (AKI). However, morbidity and mortality may be decreased by a thorough understanding of considerations related to renal disease.