Abstract: High altitude is an independent risk factor for acute kidney injury （AKI）. In early stage, normal kidneys may modulate their functions and structures to adapt to a high plateau. Individuals progressing to AKI have a higher mortality. At the level of kidney, physiological adaptation to a high altitude has been poorly elucidated. Our understanding of kidney injury in a plateau environment is insufficient so that treatment strategy is not targeted. It may easily delay the disease and miss the best time for treatment. This review focused upon changes in renal blood flow, hypoxic renal diuretic effect, renal intrinsic cells and renal tubulointerstitial function of kidneys during a rapid altitude exposure and provided theoretical rationales for managing kidney injury in simulated high-altitude.