In the last decade, epidemiological studies worldwide have shown an increase in the incidence of acute renal failure in critically ill patients [1–3]. The consequences of renal failure in the critically ill are well recognized. Despite recent advances in renal replacement therapy, the mortality rate from acute renal failure remains high, ranging from 20–50 %. The increased incidence may be due in part to the changing demographic of the critically ill patient. The increasing age of the population, as well as increased co-morbidities, such as hypertension and diabetes mellitus, increase the susceptibility to renal injury. Increasing incidence of sepsis, use of nephrotoxic drugs, and the use of radio contrast media all contribute to the increased likelihood of acute kidney injury (AKI).