Introduction: This study evaluates the quality acute kidney injury (AKI) care in two tertiary care hospitals of an NHS Trust. Methods: Adult patients meeting the clinical and biochemical criteria for AKI diagnosis were eligible for inclusion. Renal ward or intensive care admissions, patients with end-stage kidney disease or receiving palliative care were excluded. Patients were selected from a database of all reported cases of AKI that occurred during May 2023. Two investigators independently reviewed case notes and collected data using a proforma based on a national audit tool. Outcomes were reported as proportions and compared between AKI stages. Results: Data points were extracted from 28 (AKI 1), 27 (AKI 2) and 29 (AKI 3) patients. On recognition of AKI, acid-base balance was performed in 14%, 44% and 66%. Urinalysis was performed in 11%, 15% and 14%. Renal Ultrasound was performed in 15%, 11% and 31%. Sepsis screening was done in 25%, 33% and 66%. Fluid balance was monitored in 36%, 37% and 55%. Management involved volume replacement in 61%, 74% and 86%. Diuretics were administered in 15%, 11% and 14%. Diuretics were withheld in 14%, 15% and 18%. Medications review was performed in 21%, 37% and 72%. Catheterisation was done in 29%, 37% and 72%. A nephrology referral was made in 7%, 45% and 18%. Discussion: Compliance with national guidance for the investigation and management of AKI is suboptimal. We identify a need to improve clinician education in its management principles alongside the indications for specialist input.