Chronic renal failure is a syndrome of progressive loss of renal function that results in loss of urinary concentrating ability, retention of nitrogenous and other metabolic end products, alterations in electrolyte and acid-base status, and dysfunction of several hormone systems. This article describes the prevalence, causes, clinical signs, diagnostic evaluation, and management of horses afflicted with chronic renal failure. It is hoped that this article illustrates that chronic renal failure, when detected in the earlier stages of disease, can be managed successfully in the short-term allowing owners to enjoy a period of time of ongoing productivity, performance, or companionship until loss of condition reaches the point that euthanasia becomes warranted.