Leptospirosis is the most important zoonosis in the world. Patients are typically young men. Several factors are involved in acute kidney injury (AKI) in leptospirosis, including direct nephrotoxic action of the leptospira, hyperbilirubinemia, rhabdomyolysis and hypovolemia. The major histological findings are acute interstitial nephritis and acute tubular necrosis. Leptospirosis-induced AKI is usually nonoliguric and hypokalemic. Tubular function abnormalities precede a decline in the glomerular filtration rate, which could explain the high frequency of hypokalemia. Antibiotic treatment is efficient in the early and late and/or severe phases. For critically ill leptospirosis patients, the following measures are recommended: early and daily hemodialysis; low volume infusion (due to the risk of pulmonary hemorrhage); and lung-protective strategies. Mortality in leptospirosis-associated AKI is around 22%.