Purpose: to optimize the surgical treatment of atherosclerotic lesions of the abdominal aorta with combined atherosclerosis of the renal arteries. Object and research methods. The frequency of development and severity of acute postoperative kidney damage (APKD) was determined in 185 patients after abdominal aortic aneurysm resection and aorto-bifemoral shunting with occlusive damage of the terminal aorta and iliac arteries. APKD was determined by the RIFLE scale. Results. The risk of developing APKD was established before surgery in 23% of patients with abdominal aortic aneurysm and occlusive-stenotic lesions of the terminal aorta and iliac arteries. In the postoperative period, the degree I was found in 20%, F — in 7% of patients. Conclusion. Determining the risk of developing APKD in the preoperative period using the optimized RIFLE score is an important and necessary prerequisite.