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Acute kidney injury (AKI) of infectious aetiology is a complex condition that requires a comprehensive microbiological evaluation. This includes sepsis workup, evaluation of urinary tract infection (UTI), assessment for viral, fungal, and bacterial infections, consideration of the patient's microbiome, and vigilance towards antibiotic toxicity. Advanced molecular diagnostic tools such as metagenomic sequencing and rapid point-of-caretesting, may offer future advances in accurate and timely identification of infectious aetiologies in AKI. Careful antibiotic selection, dosing, and duration, taking into account renal function and potential toxicity, are crucial in the era of increasing antibiotic resistance. The information presented in this review were obtained through a thorough literature search using relevant search terms on various databases including PubMed, Embase, and Cochrane Library. The review identified bacterial sepsis and UTI as common infectious syndromes associated with AKI, but also emphasized the need to consider other infectious aetiologies including viral, fungal and parasitic infections in certain clinical scenarios. The review also discussed the potential role of advanced molecular diagnostic tools in identifying infectious aetiologies in AKI and the importance of careful antibiotic selection, dosing, and duration. In conclusion, a comprehensive microbiological evaluation, coupled with the use of advanced diagnostic techniques and antibiotic stewardship, is vital for the effective management of AKI from suspected infectious aetiology, which can aid optimize patient outcomes.