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Purpose: This study aimed to determine whether performing bedside ultrasound impacts the occurrence of acute kidney injury (AKI) in the immediate postoperative period (POP) of high-risk surgery patients. Methods: POP patients were randomly assigned to two groups: (i) ultrasound (US) group, in which hemodynamic management was guided with clinical parameters supplemented with the bedside US findings; (ii) control group, hemodynamic management based solely on clinical parameters. Two exams were performed in the first 24 h of admission. Results: Fifty-one patients were randomized to the US group and 60 to the control group. There was no significant difference for incidence of AKI in both groups assessed 12 h (31.4% vs 35.0%, P = 0.84), 24 h (27.5% vs 23.3%, P = 0.66), or 7 days (17.6 vs 8.3%, P = 0.16) after surgery. No difference was found in the amounts of volume administered over the first 12 h (1000 [500–2000] vs. 1000 [500–1500], P = 0.72) and 24 h (1000 [0–1500] vs. 1000 [0–1500], P = 0.95) between the groups. Patients without AKI in the control group received higher amounts of volume during the ICU stay. Conclusion: The use of bedside US in the immediate postoperative period of high-risk surgery did not show benefits in reducing AKI incidence. [ABSTRACT FROM AUTHOR]