Acute kidney injury (AKI) causes increased morbidity in critically ill children and damage to the kidney, a central mediator of homeostasis in the body, affects survival. The incidence of AKI in pediatrics is significant and despite alarming data, therapeutic interventions have failed to affect a meaningful difference in outcomes. In this review, we will discuss the epidemiology of AKI in pediatrics, treatment strategies attempted to date, experimental therapies targeting molecular patterns associated with AKI, and highlight the needed direction of AKI research and management. Prospective trials in pediatrics are needed to test the validity of diagnostic tools, to identify the point of most efficacious intervention, and to underscore the therapies that can be effective in the different downstream effects of AKI. In this review, we will discuss recent patents and advancements in diagnosis, management, and prevention.