The risk of developing acute kidney injury (AKI) is significantly increased in the elderly. It is the age-related renal and systemic changes as well as frequent comorbidities that render older individuals greatly susceptible to acute renal impairment. Although most often multifactorial, specific etiologies such as renal hypoperfusion due to cardiac failure, dehydration or hypotension of any cause, as well as sepsis, drug toxicity, surgery, or obstructive causes are often present. Contrast-induced nephropathy and atheroembolic disease are also frequently seen, especially in an acute care setting. Serum creatinine is most commonly used for diagnosis, despite it having several limitations, especially in the elderly. The mainstay of management is prevention of further deterioration, as the chances of renal recovery may be lower in older patients.