Background Acute kidney injury (AKI) develops in up to 30% of patients undergoing cardiac surgery and the development of AKI is independently associated with substantial short- and long-term mortality. Objective This review will focus on pathogenesis, prediction, prevention and treatment of AKI. Contents The pathogenesis of AKI involves multiple pathways, including hemodynamic, inflammatory, metabolic, nephrotoxic factors, etc. Clinical studies have identified predictors for cardiac surgery-associated AKI that can be used effectively to determine the risk for AKI in patients undergoing cardiac surgery. Furthermore, several strategies, such as decreased invasive procedures in those at greatest risk, perioperative use of natriuretic peptide and fenoldopam, preoperative hydration, preoperative treatment of anemia, and postoperative early use of renal replacement therapy, have shown some renal protection. Tend As increasing knowledges of the pathogenesis of AKI after cardiac surgery, we will be able to direct preventive and therapeutic strategies better.