Case Study: Leptospirosis is a re-emerging zoonotic disease with a high burden in tropical and subtropical regions, including Indonesia. The clinical course of AKI in leptospirosis can range from non-oliguric, hypokalemic AKI to severe oliguric/anuric renal failure requiring Renal Replacement Therapy (RRT). We present a case series of three patients admitted with leptospirosis-associated AKI. Case 1: A 48-year-old female presented with a 2-day history of fever, nausea, epigastric pain, shortness of breath, and reduced urine output. The patient developed an icteric sclera and a bloated abdomen, with ultrasound revealing hepatosplenomegaly. The patient required a total of 7 hemodialysis (HD) sessions and a series of blood transfusions. The patient’s clinical status improved, and he was discharged on Day 19. Case 2: A 31-year-old male garbage collector came with complaints of a 1-week history of fever, right upper quadrant (RUQ) pain, dyspnea, jaundice, and severe oliguria. The patient was undergoing urgent HD on Day 2. He received a total of 4 HD. Following HD, his urine output rapidly increased. At the 2-week follow-up, serum creatinine had decreased to 1.5 mg/dL. Case 3: A 35-year-old male with a history of hypertension and exposure to pets presented with 10 days of nausea, vomiting, epigastric and RUQ pain, pale stool, jaundice, and oliguria. The patients had unstable vital signs and critical abnormalities in the laboratory test results. The patient was admitted to the ICU, requiring intubation. Abdominal distention was observed, along with continuous bleeding from the nasogastric and endotracheal tubes. HD was delayed due to initial family refusal. The patient died in cardiac arrest due to multiple organ failure. Early diagnosis of kidney injury related to leptospirosis is crucial for initiating therapy and appropriate interventions. This can reduce kidney injury, lower the risk of severe complications, and limit disease progression.