Acute kidney injury (AKI) is a syndrome that describes a sudden reduction in renal function as assessed by the level of serum creatinine. AKI represents a spectrum of disease that has important long-term consequences for patients even without the development of frank renal failure. AKI may be difficult to identify in the community, but up to 65% of AKI develops prior to hospitalisation and 30% may be preventable. Complications of AKI account for 1% of the NHS budget. NHS public health campaigns, including ‘Think Kidneys’ have targeted the prevention and early recognition of AKI to improve care for this patient group. This article will review the key aspects of management of AKI in primary care, the correct identification of high-risk patients, early testing to stratify and manage patients according to AKI level and onward referral of patients requiring targeted hospital interventions.