Acute kidney injury (AKI) is a complex, life-threatening condition with various causes, including ischemic injury and nephrotoxic exposure. Management focuses on treating the underlying cause, along with supportive care such as fluid management, vasopressor therapy, and kidney replacement therapy (KRT). Blood pressure targets are often higher in AKI, with studies showing that maintaining a mean arterial pressure (MAP) of 65 mmHg or higher can improve kidney perfusion. However, the optimal MAP target varies based on patient characteristics and AKI etiology. KRT initiation remains controversial, with no consistent evidence supporting early dialysis. There are no targeted pharmacotherapies for AKI itself, but some exist for its complications. Medication management is crucial in AKI due to changes in renal function and dialysis support, which can lead to toxicity or underdosing. Blood pressure optimization, appropriate use of KRT, and medication management are key objectives in AKI treatment. However, controversies persist, and emerging therapies such as stem cell treatments and novel biomarkers are being investigated. Nephrotoxic agents should be avoided in AKI to minimize harm. While some treatments like diuretics and bicarbonate are debated, careful dosing based on individual factors is essential for safety and efficacy. Future research should focus on improving AKI management, including studying non-critically ill patients and exploring novel therapies. Overall, AKI remains a significant health issue requiring continued research and refinement of treatment strategies.Acute kidney injury (AKI) is a complex, life-threatening condition with various causes, including ischemic injury and nephrotoxic exposure. Management focuses on treating the underlying cause, along with supportive care such as fluid management, vasopressor therapy, and kidney replacement therapy (KRT). Blood pressure targets are often higher in AKI, with studies showing that maintaining a mean arterial pressure (MAP) of 65 mmHg or higher can improve kidney perfusion. However, the optimal MAP target varies based on patient characteristics and AKI etiology. KRT initiation remains controversial, with no consistent evidence supporting early dialysis. There are no targeted pharmacotherapies for AKI itself, but some exist for its complications. Medication management is crucial in AKI due to changes in renal function and dialysis support, which can lead to toxicity or underdosing. Blood pressure optimization, appropriate use of KRT, and medication management are key objectives in AKI treatment. However, controversies persist, and emerging therapies such as stem cell treatments and novel biomarkers are being investigated. Nephrotoxic agents should be avoided in AKI to minimize harm. While some treatments like diuretics and bicarbonate are debated, careful dosing based on individual factors is essential for safety and efficacy. Future research should focus on improving AKI management, including studying non-critically ill patients and exploring novel therapies. Overall, AKI remains a significant health issue requiring continued research and refinement of treatment strategies.