Emergency surgery is burdened by high rates of complications and mortality. These rates increase significantly in the presence of comorbidities, among which the prognostic role of chronic renal disease (CKD) stands out. The uremic patient is particularly demanding, especially in the advanced stages of the disease, because CKD increases the risk of postoperative morbidity and mortality after major abdominal surgery. Moreover, acute kidney failure (AKI) alone, AKI on top of CKD, and end-stage renal disease (ESRD) are independent mortality risk factors, whereas CKD alone is not. AKI and CKD are interrelated syndromes, with the presence of CKD being a significant risk factor for developing AKI. In this chapter the most valid diagnostic and therapeutic approaches are analyzed as well as the possibilities of rebalancing the uremic patient before the emergency procedure. The appropriate precautions are therefore evaluated regarding the use of any radiological contrast media and the dosage of drugs, in particular antibiotics. Finally, the specific aspects of the main surgical abdominal emergencies that can occur in the uremic patient are focused on and some pathological conditions that are almost peculiar to this type of patient are highlighted.