Kidney damage is common in patients with severe forms of COVID-19 and associated with poor prognosis. The causes and nature of kidney damage at COVID-19 have not yet been determined. Th e study aimed to investigate the incidence, causes and nature of kidney damage in patients with COVID-19. Th e data obtained from 220 patients, died from COVID-19 between April 20 and May 20, 2020. At the time of hospitalization, 55 (25%) patients had features of chronic kidney disease (CKD). Acute kidney injury (AKI) developed in 135 patients (61%), its frequency did not differ signifi cantly depending on the baseline renal function (67% vs 61% in patients with CKD and with initially normal function, respectively). The only signifi cant predictor of AKI development was the duration of mechanical ventilation (6.1 vs 1.7 days). The number of patients receiving mechanical ventilation or ECMO for 5 or more days was 43% vs 10% for AKI and normal renal function, respectively. Pathologic examination revealed preexisting renal pathology in 76 patients (43%), including 34 out of 55 (62%) patients who had a decrease in glomerular fi ltration rate (GFR) at the time of hospitalization, and in 40 out of 165 (24%) patients who had normal kidney function at admission (P