Acute renal failure frequently occurs in the intensive care unit as a primary or secondary event in association with trauma, surgery, or comorbid medical disease. An increasingly common thread linking surgical and medical disease management is the abdominal compartment syndrome. In particular, the rise of early goal-directed therapy for the initial resuscitation and management of severe sepsis and septic shock is associated with an increased frequency of secondary abdominal compartment syndrome. This paper will explore the pathophysiology underpinning the abdominal compartment syndrome and its contribution to acute kidney injury and acute renal failure with regard to intra-abdominal pressure dynamics, preload limitation, and afterload augmentation. Diagnostic modalities and therapeutic interventions will be addressed as a means of reducing the frequency of acute kidney injury and acute renal failure in the critically ill.