Medication-related acute kidney injury (MR-AKI) is an important and potentially preventable cause of acute kidney injury in hospital and community settings. Its consequences may extend beyond the initial episode, contributing to persistent kidney dysfunction, chronic kidney disease (CKD), cardiovascular complications, and mortality. Clinical pharmacists can contribute throughout the MR-AKI care pathway by identifying patients at increased risk, supporting early detection, evaluating medication-related causality, recommending drug withdrawal or dose modification, optimizing supportive pharmacotherapy, and facilitating the appropriate reintroduction of essential treatments. This narrative review examines the epidemiology and principal mechanisms of MR-AKI and discusses pharmacist-led approaches to risk assessment, kidney function surveillance, medication review, and clinical management. Particular attention is given to the structured assessment of suspected drug-induced injury and to evidence-informed decisions regarding the temporary interruption, subsequent reintroduction, or avoidance of selected therapies, including renin–angiotensin system inhibitors, sodium–glucose cotransporter 2 inhibitors, immune checkpoint inhibitors, and other potentially nephrotoxic medications. The review also considers post-AKI monitoring, transitions of care, implementation challenges, and priorities for future research. By integrating risk identification, timely medication intervention, and individualized reassessment of treatment, this review proposes a practical pharmacist-led framework to support kidney safety while preserving access to therapies with established clinical benefits. Prospective studies are needed to evaluate the framework’s feasibility and its effects on patient outcomes, medication-related harm, and continuity of evidence-based treatment.