Acute kidney injury (AKI) is common in hospitalized patients with mortality varying from 10% to 80%. It is crucial to know the incidence and etiology of AKI to promote prevention strategies. Our study aimed at obtaining a comprehensive review of the pattern and spectrum of patients who presented for emergency hemodialysis to Kasr Al-Aini Hospital between October 2012 and October 2014. We analyzed clinical and laboratory factors in all such patients. Two thousand twenty three patients were included of which patients with AKI were 728 patients (36%). Cardiac diseases were the cause of AKI in 171 patients, other prerenal causes were found in 55 patients, drug induced AKI in 113 patients, and obstetric causes in 48 patients. Glomerulonephritis was responsible for AKI in 101 patients, lupus nephritis was found in 33 patients of them. Patients with chronic kidney disease who presented with acute exacerbation were 243 patients (12%). Patients who were discovered to be with end-stage renal disease during their first presentation itself were 1052 patients (52 %). Diabetes mellitus was present in 50.12%, while hypertension was present in 29.56%. Hepatitis C virus was present in 17.3%, while HBsAg was present in 0.8%. Drugs and obstetric causes represented a larger fraction among our cases than seen in developed countries. Lupus nephritis was also a common cause of AKI.