The abdominal compartment syndrome (ACS) occurs most commonly in the setting of major trauma and complex abdominal surgical procedures. The syndrome reflects the adverse physiological consequences of an acute increase in intra-abdominal pressure (generally >18 mm Hg). The effects of increased abdominal pressures on the kidney were initially described in 1876 and include impairment of renal blood flow and glomerular filtration resulting in oliguria or anuria and acute kidney dysfunction. These effects are magnified by the concomitant effects of increased intra-abdominal pressure to impair venous return and cardiac output. Patients with intra-abdominal hypertension (IAH) can be easily detected using simple methodology. If employed early, abdominal decompression to lower IAH is associated with restoration of organ function and avoidance of the ACS. However, the overall mortality associated with this syndrome remains high. In postsurgical, trauma patients, or those at risk, ACS should be considered as a potential etiology for acute kidney dysfunction and intra-abdominal pressures should be measured, monitored and when necessary intervened upon in order to attempt to improve organ dysfunction.