The chapter comprises of complete detail information on the impact associated with the kidney diseases and their management with reference to the acute coronary syndrome. Any kidney disease including acute kidney injury (AKI) or chronic kidney disease (CKD) and acute coronary syndrome (ACS) are regarded as medical entities which are highly prevalent in population. It has increased rates of mortality and morbidity by affecting the other systemic organization of the body and causes cardiorenal syndrome (CRS) which is an acute worsening of heart function leading to kidney injury or dysfunction. The chapter also mentions the impact of chronic kidney disease on acute coronary syndrome, its outcome and management. The chapter also highlights on antithrombotic therapy in chronic kidney disease patients with acute coronary syndrome. Rivaroxaban is a factor Xa inhibitor which has been approved by USFDA, for stroke prevention in nonvalvular AF, replacing warfarin.