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Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries.