Anaesthetists need a working understanding of the implications of renal impairment for the safe conduct of anaesthesia. Patients with renal failure are often encountered when managing elective or emergency surgical cases. In addition, it is fundamental to consider how kidney injury frequently forms part of the clinical picture during resuscitation and optimisation of acutely unwell patients in the emergency department or critical care. The functions of the kidney are multiple, and beyond the scope of this paper. The aim of this review is to summarise current classifications of renal impairment and explore the evidence underpinning relevant practice in anaesthesia. Patient groups include those with chronic renal failure, patients with acute renal failure, and also patients with normal preoperative renal function but who have a high risk of developing peri-operative kidney injury. There is a dearth of strong evidence to guide anaesthetic practice with regards to renal failure. As a result, many of the studies quoted here are small cohorts, case series, or case reports. In general, anaesthetists are still mainly guided by their knowledge of physiology, pharmacology and pathology to safely manage patients with kidney injury.

Keywords: Acute kidney injury, Anaesthesia, Chronic kidney injury