Objective To explore the high-risk factors of renal injury after treatment of acute paraquat poisoning and establish a prediction model of prognostic risk and provide data reference for determining the high-risk factors of renal injury after treatment of acute paraquat poisoning and predicting the prognostic effect. Methods The clinical data of 200 patients hospitalized in Guangzhou 12th people′s hospital due to acute paraquat from September 2017 to April 2021 were studied. The patients were divided into groups according to whether they had acute renal injury during the course of treatment. The general sociological data, clinical indicators, disease history, epidemiological data of the two groups were compared and analyzed. Clinical data such as imaging examination were included in univariate and multivariate logistic regression analysis to explore its high-risk factors. The statistically significant indexes in the results of multivariate logistic regression analysis were included in the nomogram to establish the prediction and early warning model of prognostic effect. Results Among 200 patients with acute paraquat poisoning, 154 patients had acute renal injury, and the incidence was 77.00%. Among the patients with acute renal injury, 41 cases had a good prognosis, accounting for 26.62%, and 113 cases had a poor prognosis, accounting for 73.37%. Multivariate logistic regression analysis showed that age (OR=3.547, 95% CI: 2.108~9.723), paraquat dose (OR=12.425, 95% CI: 5.294~19.837), time from poisoning to admission (OR=8.659, 95% CI: 4.123~12.346), Apache Ⅱ (OR=4.821, 95% CI: 2.163~9.825), complicated with serious diseases (OR=8.518, 95% CI: 3.327~11.637), plasma lactic acid (OR=2.225, 95% CI: 1.037~4.338) patients with acidosis (OR=3.634, 95% CI: 2.317~10.527) and ion disorder (OR=3.725, 95% CI: 1.525~8.658) were more likely to have poor prognosis of renal injury. Treatment measures should be taken to ensure the prognostic effect. Hemoglobin (OR=0.753, 95% CI: 0.418~0.939) was a protective factor for the prognosis of renal injury caused by acute paraquat poisoning. Conclusion Among the patients with renal injury after acute paraquat poisoning, the elderly and AKI patients with serious diseases has a poor prognosis. Higher dosage, later medical treatment time are independent risk factors for the poor prognosis of AKI patients after acute paraquat poisoning. Hemoglobin is a protective factor for the prognosis of AKI patients. Early detection and treatment are helpful to improve the prognosis