Background: The paediatric intensive care unit (PICU) is critical in providing demanding and necessary treatment to very unwell children. PICU children have a much greater risk of morbidity and mortality in both underdeveloped and developed nations. Objective: The aim of this study was to assess the urine albumin creatinine ratio (ACR) in renal injury in septic children and it's role in predicting outcome. Patients and Methods: This study was carried out in Pediatric Intensive Care Unit and clinical pathology department at Zagazig University Hospitals in the period from April 2022 to October 2022. It was approved by Institutional Review Board- Zagazig University (IRB 9482). Written informed consent was taken from all parents.  Results: This study included 68 patients with median age 1 year, females represented 47.1% of them and males were (52.9%). Our study revealed that, blood culture was positive in 80.9% of patients and 44.1% had sepsis degree 3 .In the current study, median albumin/creatinine ratio on admission was 319 mg/g which significantly decreased to 253 mg/g after 24 hours. Our study showed that, there is statistically significant relation between mortality and ACR on admission and after 24 hours (significantly higher in those with non-survivors). In non-survivors, there was significant increase in ACR while there was significant decrease in ACR in survivors after 24 hours. Concerning trend for ACR, 97.1% of non-survivors had increasing ACR after 24 hours versus one patient of survivors. Conclusion: Elevated urinary ACR is associated with the severity of sepsis, morbidity, and mortality.