Acute kidney injury (AKI) is a major health problem in China say researchers. Based on their analysis of data from 44 hospitals, Yang et al. estimated that 1.4–2.9 million people with AKI were admitted to hospital in China in 2013, but 74.2% of these cases were not recognized. Moreover, only 21.4% of patients with an AKI diagnosis were referred to a renal specialist. Among the referred patients, only 59.3% of those with indications for renal replacement therapy received this treatment. Delayed recognition of AKI was an independent risk factor for in-hospital mortality, whereas renal referral reduced the risks of AKI under-recognition and mortality.