Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive and has a lower operative mortality than conventional surgery. The relationship between renal function and outcome following open AAA repair has been extensively investigated, but less work has been undertaken with respect to renal function and outcome after EVAR. We reviewed the literature (Medline and PubMed databases) between 1991 and 2007 to investigate the relationship between EVAR and renal dysfunction. Our review found that perioperative renal dysfunction is attenuated by EVAR. However, dialysis rates after EVAR are similar to those after open surgery. EVAR patients develop progressive deterioration in renal function over time. The etiology is unclear and probably multifactorial, involving embolization, contrast media, and graft misplacement. The effect of transrenal endograft fixation on long-term renal function is unknown, but the technique may be associated with a significantly increased risk of renal infarction. The etiology of the renal injury during and after EVAR needs further evaluation, and techniques aimed at renal preservation should be pursued.