This presentation delves in to the complex enigma of Acute Kidney Injury. The incidence, etiology, staging, and treatment are discussed. AKI is associated with significant mortality and morbidity. Management is impacted by hypercatabolism, fluid status, protein-energy wasting (PEW), multi-organ dysfunction, severity of the disease, and patient characteristics. The current pandemic contributes to AKI and there are issues with hospitals having sufficient renal replacement therapy (RRT) equipment. Nutrition interventions are individualized and are aimed at fluid management, gentle nutrition repletion with malnutrition, prevention of PEW, and replacement of losses due to RRT. Patients may need to continue RRT after hospital discharge. Outpatient dialysis centers are often challenged by this patient population which can transition off dialysis with renal recovery or transition to ESRD.