Objective　To explore the early predictive value of urinary insulin-like growth factor binding protein 7 (IGFBP-7) in acute kidney injury (AKI) in critically ill children. Method　The children admitted to PICU from May to August 2012 were selected as the research subjects. They were divided into mild AKI (AKI phase 1), severe AKI (AKI phase 2 and 3) and non-AKI groups. The IGFBP-7 levels in first 24-hour urinary were detected and the pediatric risk of mortality Ⅲ (PRISM Ⅲ) score was calculated 24 hours after admission. Multivariate logistic regression analysis was used to evaluate the relationship between urinary IGFBP-7 and AKI after correction of confounding factors. The early predictive value of urinary IGFBP-7 for AKI in critically ill children was evaluated by ROC and AUC. Results　A total of 144 children with critical illness were enrolled. AKI occurred in 21 children (14.6%) within 120 hours after sample collection, including 11 children with severe AKI. The urinary IGFBP-7 level and PRISM III score in the first 24 hours after PICU admission were higher in severe AKI group than those in mild AKI group and non-AKI group, and differences were significant (both P<0.05). Logistic regression analysis showed that urinary IGFBP-7 was an independent risk factor for severe AKI (OR=2.93, 95%CI: 1.07~8.03, P=0.037) after adjusting for age, body mass and PRISM III score, and its predicting value was 0.79 by AUC (95%CI: 0.66~0.92, P=0.001). Conclusion Urinary IGFBP-7 is an independent predictor of severe AKI in critically ill children and has early predictive value.