Acute renal failure in intensive care is an independent factor in morbidity and mortality. The prevalence of AKI in patients with hemodynamic instability in the ICU setting can be as high as 50%. The definition is based on the 2012 KDIGO criteria, which combine a clinical parameter represented by the rate of diuresis, and a biological parameter that evaluates the variation in creatinine levels. Prevention starts with identifying subjects at risk, and optimizing systemic and locoregional hemodynamic conditions. The use of products with nephrotoxic potential must be carefully balanced in terms of benefit and risk. The therapeutic approach is essentially symptomatic, with the main aim of preventing worsening of renal damage while awaiting recovery of renal dysfunction.