Background: The pediatric intensive care unit (PICU) plays an important role in delivering demanding and required care to seriously ill children. In both developing and developed countries, PICU children have a considerably higher risk of morbidity and death. The aim of this study was to assess the urine albumin creatinine ratio as predictor of renal injury in septic children and it's role in predicting PICU outcomes. 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: Our study revealed that, blood culture was positive in 80.9% of patients and 44.1% had sepsis degree 3. In the current study, PRISM-III score ranged from 4 to 28 with median 14.5. p-SOFA on admission ranged from 3 to 19 with median 9. P-SOFA after 48 hours ranged from 3 to 20 with median 10. Glasgow coma scale ranged from 4 to 14 with mean 9.4. In the current study, median albumin/creatinine ratio on admission was 319 mg/g which significantly decreased to 253 mg/g after 24 hours. Thirty-five patients (51.5%) had increasing ACR and 33 patients had decreasing ACR. Concerning cause of admission, 39.7%, 20.6% and 11.8% of patients had respiratory, neurology and hepatic diseases respectively. In our study regarding outcome, thirty three patients survived till end of study (48.5%). In the present study, there is statistically significant very strong positive correlation between albumin/creatinine ratio on admission and after 24 hours and PRISM-III scores. In this study, there is statistically significant very strong positive correlation between albumin/creatinine ratio on admission and after 24 hours and p-SOFA scores on admission and after 48 hours. In this study, there is statistically significant negative correlation between albumin/creatinine ratio on admission and after 24 hours and Glasgow coma score. In the present study, there is statistically significant positive correlation between PICU stay and all of albumin/creatinine ratio on admission and after 24 hours, PRISM-III, p-SOFA on admission and after 48 hours. Conclusion: In conclusion, elevated urinary ACR is associated with the severity of sepsis, morbidity, and mortality. ACR was found to have significant relation to the need for inotropes. In addition, ACR had a good correlation to the duration of the PICU stay. ACR is an easy, cost-effective, and reliable test for predicting morbidity and mortality in a PICU setting.