Sepsis in equine describes a broad range of disorders with different underlying causes and often different prognoses. The syndrome can rapidly progress to septic shock and can result in hypoperfusion with subsequent multiple organ dysfunction including acute kidney injury (AKI). Despite extensive research and progress have been performed in several fields in equine medicine, the incidence as well as the mortality rate of sepsis-induced AKI remains unclear. Although sepsis is considered as the leading cause of AKI, the underlying pathophysiologic mechanisms are not completely understood and still a subject of ongoing debate. The aim of this article is to provide a comprehensive review of the pathophysiology of sepsis-induced AKI, and to outline the diagnostic as well as the therapeutic potentials of the disease.