Abstract Background: Mortality rates in acute kidney injury (AKI) are still very high despite enormous research and technological advances in its management. It varies between 40-50% in hospitalized patients and 70-90% in cases admitted into intensive care units.Management of severe AKI is capital intensive and majority of Nigerians with the disease die prematurely because they can hardly afford cost of renal replacement therapy (RRT). Reasons for the persistent poor survival may vary from one region to another, even in the same environment.Objective: To review clinical features and factors contributing topoor outcome of patients with AKI in Ilorin, Kwara State.Subjects and Method: Retrospective appraisal of acute kidney injury at University of Ilorin Teaching Hospital, Ilorin, Nigeria (Jan.1989- Dec. 2009.) All patients that met stage 3 RIFLE criteria forAKI and presented primarily or referred to our renal care centre were studied. RIFLE is the acronym for staging AKI which means Risk of renal dysfunction, Injury to the kidneys, Failure of renal function persisting for 24hours, Loss of renal function persisting formore than 1 month and End stage kidney disease (loss of function for more than 3 months). A total of 113(52males and 61 females) outof 1,275 renal patients that had AKI (8.86%) were reviewed.Results: Unusual weakness, oliguria, altered sensorium, vomiting and hiccups were major presenting features. About 80.5% of the patients were less than 40 years of age with male and female meanages of 27.29 + 7.77 and 29.15+ 6.98 years respectively. The aetiological factors were septicaemia, severe gastroenteritis, acute glomerulonephritis, drug induced, ante/post partum haemorrhage and obstructive uropathy. Overall mortality rate was 47.6%. Sixtythree patients were managed conservatively with 62% mortality while 33 and 9 patients had haemodialysis and peritoneal dialysiswith mortality rates of 15% and 67% respectively.Conclusion. Aetiological factors were largely preventable and treatable conditions. The main contributory factors to highmortality rate were ignorance, late presentation, delayed intervention therapy, bleeding diathesis, severe infections, financial constraints and high cost of dialysis. Haemodialysis appear to be abetter modality of treatment than peritoneal dialysis for severe AKI in our environment.