Recent reports from China, Italy, and the US indicate that there is a 25-37% incidence of AKI among critically ill COVID-19 patients (Singh 2020, Hirsch et al. 2020). In a study of 5,449 hospitalized COVID-19 patients, acute kidney injury (AKI) was observed primarily in patients with respiratory failure, with AKI developing in 89.7% of patients on mechanical ventilation compared with 21.7% of patients not requiring ventilation.

Based on laboratory reports, experts speculate that there are two likely causes of COVID-19 induced AKI. One is a systemic inflammatory response resulting from a cytokine storm, and the other is a direct nephrotoxic effect of the COVID-19 virus.

In a prospective study of 701 hospitalized patients with COVID-19, more than 40% had evidence of pre-existing kidney disease upon admission. An explanation given for this phenomenon is that these patients are known to have a higher risk for upper respiratory tract infection and pneumonia.

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