Background: Acute kidney injury (AKI) is more prevalent in critically sick paediatric patients owing to variables like mechanical ventilation, severe infection and nephrotoxic medications. This study aimed to assess urinary TIMP-2 * IGFBP-7 role as an earlier predictor of AKI in critically ill children. Methods: This is case control study included pediatric patients admitted to PICU and at risk for AKI (Group I) and age- and sex- matching control group (Group II) which was split into 2 subgroups: Group II A that included children admitted to PICU without risk of AKI and Group II B as a control group that included healthy children not admitted to PICU. Children were exposed to a comprehensive history taking, clinical examination, and laboratory examinations. Two urine sample 48 hour apart for urinary tissue inhibitor of metalloproteinase-2 (TIMP-2), insulin-like growth factor binding protein-7 (IGFBP-7). Results: Cases with risk of AKI showed significantly higher TIMP2 and IGFBP7*TIMP2 those were the substantial AKI predictors, whereas no substantial change was seen among the groups in IGFBP7 levels. The described markers showed no significant differences according to the AKI etiological factors, long term outcome, AKI 30-day mortality or ICU stay length (p>0.05). Conclusions; The levels of IGFBP-7*TIMP-2 marker in the critically-ill pediatric population could be a predictor of AKI risk. The studied markers did not show significant difference according to the mortality. Moreover, they did not show significant correlation with ICU stay length.