Sepsis-associated acute kidney injury (SA-AKI) is a complex, life-threatening condition resulting from a dysregulated immune response to infection, leading to organ dysfunction. It is common in critically ill patients and involves multifactorial pathophysiology including inflammation, endothelial damage, mitochondrial dysfunction, and other pathways. SA-AKI increases the need for renal replacement therapy and is linked to poor long-term outcomes. Risk stratification and emerging subphenotyping methods aim to improve diagnosis and treatment. Current management focuses on prevention and supportive care, as no specific pharmacotherapies exist. Ongoing research explores precision medicine approaches and novel interventions to improve outcomes in this population.