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Indonesia is a malaria endemic country with high levels of morbidity and mortality. In Aceh, by the end of 2016, based on the data from Annual Parasite Incidence, the incidence rate was 0.1 per 1.000 population at risk of malaria. One of severe malaria complications is malaria-related acute kidney injury. The death increases threefold by the presence of malaria acute kidney injury (MAKI). A 56 years old male farmer was a resident in Buket Meuh Village, Meukek, South Aceh, Indonesia, which was a malaria endemic area. He had an on and off fever for 7 days, shivering, sweating, joint pain, headache, nausea, vomiting, yellow eyes, raving and concentrated tea-colored urine during 4 days prior to hospital admission with a small amount of urine of 200 cc in 24 hours. The diagnosis was built based on the severe malaria clinical descriptions such as black water fever (BWF) with MAKI complications and the Plasmodium vivax trophozoite finding in the blood smear examination. The given therapy was artemeter injection followed by primaquine oral, DHP oral for three days and 6 times hemodialysis.