Perioperative acute kidney injury (AKI) remains challenging for the anesthesiologist and surgeon. It is one of the most common, heterogeneous, and severe complications. Perioperative AKI is associated with increased morbidity, mortality, the need for renal replacement therapy (RRT), prolonged hospital stays, and escalating costs and healthcare resource utilization. Concomitant comorbidities, age, size, type, timing, the urgency of surgery, improper fluid management, anemia, hyperglycemia, malnutrition, the use of blood and blood products, contrast dyes, diuretics, and exposure to nephrotoxins are the main factors in the development of AKI. The main factors involved in the pathogenesis of perioperative AKI are highly complex and include a combination of hypoperfusion, microcirculatory and endothelial dysfunction, inflammation, and tubular cell damage. The main aim of anesthesiologists should be to identify risk factors in the perioperative period and minimize the incidence of perioperative AKI through appropriate anesthesia management and the necessary protective and preventive strategies. The anesthesia management should include optimization of hemodynamics, adequate organ perfusion and oxygenation, suitable monitoring, correct fluid management, anesthesia, pain control, mechanical ventilation methods, glycemic control, avoiding nephrotoxic drugs, contrast dyes, and blood transfusions, and early RRT and nutritional support. New biomarkers should be used to detect, intervene, and treat AKI promptly. We review the recent literature on the value and importance of comprehensive preoperative evaluation, optimization of risk factors, perioperative monitoring, anesthesia and pain management, preventive methods, and treatment in patients with AKI.