Objective. This study was designed to determine the evaluation value of serum miR-4299 and miR-16-5p in risk stratification of sepsis-induced acute kidney injury (SI-AKI). Methods. A total of 115 sepsis patients were enrolled and assigned to the SI-AKI group (
n
=
64
) or the sepsis-non-AKI group (
n
=
51
) based on the occurrence of AKI, and 72 healthy individuals were enrolled. Fasting venous blood was sampled from every patient before admission, before therapy, and after therapy, followed by quantification of miR-4299 and miR-16-5p by fluorescence quantitative PCR. Receiver operating characteristic (ROC) curves were drawn to evaluate the value of serum miR-16-5p and miR-4299 expression in predicting SI-AKI, and Pearson’s correlation analysis was performed to explore the associations of the two with Scr, Cys-C, and KIM-1. Results. Cases with sepsis, especially SI-AKI, presented significantly downregulated serum miR-4299 and miR-16-5p. After therapy, the expression in them increased. The area under curve (AUC) of serum miR-4299 and miR-16-5p in the prediction value for early diagnosis of SI-AKI was 0.895 (95% CI: 0.839-0.951, cutoff value: 0.780) and 0.838 (95% CI: 0.767-0.909, cutoff value: 0.775), respectively, and the AUC of them in the prediction value for clinical efficacy on the disease were 0.733 (95% CI: 0.645-0.820, cutoff value: 1.115) and 0.776 (95% CI: 0.698-0.855, cutoff value: 1.125), respectively. Serum miR-16-5p and mIR-4299 were negatively correlated with Scr, Cys-C, and KIM-1, separately. Conclusion. Both miR-16-5p and mIR-4299 are promising factors for early diagnosis of SI-AKI and dynamic evaluation of the efficacy on it.