Background: Acute Kidney Injury (AKI) is a major yet under-recognized contributor to morbidity and mortality in low- and middle income countries, including Nepal. The coexistence of communicable and non-communicable diseases, environmental exposures, and socioeconomic constraints creates a “double burden” that complicates prevention and management.

Aim: This mini-review summarizes the epidemiology, causes, diagnostic challenges, health-system gaps, and future priorities for improving AKI care in Nepal.

Sources of evidence: A narrative review of published hospital-based studies, regional data from South Asia, and international initiatives relevant to low-resource settings was conducted to synthesize current evidence. Key findings: Most AKI cases in Nepal are community-acquired and affect younger, previously healthy individuals. Common causes include infections, dehydration, insects’ envenomation and snakebite, nephrotoxic traditional medicines, obstetric complications, chemical poisoning, and emerging non-communicable diseases. Limited access to laboratory testing and kidney replacement therapy, particularly outside urban centers, contributes to delayed diagnosis and high mortality. Health-system barriers include workforce shortages, inadequate infrastructure, high out-of-pocket expenditure, and absence of national surveillance. Migrant workers represent a vulnerable population with disproportionate kidney disease burden.

Conclusions: AKI in Nepal is largely preventable but remains underdiagnosed and undertreated. Strengthening early detection through point-of-care diagnostics, expanding workforce capacity, improving access to affordable dialysis modalities, and establishing national surveillance systems are critical steps toward reducing preventable deaths and long-term kidney disease.