Acute renal failure often complicates the course of critically illness and can contribute to highmorbidity and mortality. In most cases acute renal failure represents a part of the multiple organ dysfunction syndrome and it is usually related to the ischemic and/or toxic injury of tubular cells (acute tubular necrosis, ATN). The presented paper reviews the mechanisms involved in this two types of tubular cells injury. It analyzes the measures of kidney protection during critical illness, which include optimization of systemic and intrarenal hemodynamics as well as avoidance of nephrotoxic drugs. It describes the most common nephrotoxic drugs and proposes principles of their safer use. Potential strategies to stimulate kidney function recovery are also discussed.

        Key words: acute renal failure, multiple organ dysfunction syndrome, acute tubular necrosis, hypoxia, renal perfusion, shock, nephrotoxic drugs, myoglobin, prevention.