Southwestern Australia is recognised as a global biodiversity hotspot, characterised by high diversity and endemism of vascular terrestrial plants. However, the significance of its freshwater biodiversity is not well understood. This review provides an updated account of species richness in rivers in the Mediterranean region (med-region) of southwestern Australia. Taxonomic knowledge of many aquatic invertebrate groups in this region has improved significantly in the last two decades as a result of ecological surveys and government funding for taxonomic research. Of the 662 species of plants and animals surveyed, 43% were found to be endemic to the region, yet when taxonomic groups were considered separately, levels of endemism were varied. To date, few aquatic species from the med-region are listed as threatened; however, many more species would be expected to be included if assessed against appropriate criteria. Conservation efforts are focussed on climate change mitigation and managing the impacts of broad scale land clearing for agriculture. Reserve design and location of important nature reserves on the extreme south coast, limits the ability for species' movement to cooler, wetter regions. This will necessitate supporting restoration which leads to increased resilience in freshwater ecosystems to withstand the combined effects of climate change and land use. © 2013 Springer Science+Business Media Dordrecht.