Acute kidney injury in patients with COVID-19 receiving mechanical ventilation

Acute kidney injury (AKI) has emerged as one of the most frequent and prognostically relevant complications in hospitalized patients with COVID-19, particularly among those with acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. During the pandemic, the National Institute of Respiratory Diseases (INER) in Mexico City was designated as a national referral center for critically ill patients, facing an unprecedented burden of severe respiratory failure and COVID-19-associated AKI. This narrative review integrates international and national evidence on the epidemiology, pathophysiology, diagnosis, and management of COVID-19 and associated AKI, explicitly incorporating the clinical and scientific experience generated at INER. We discuss the high incidence of AKI observed in Mexican cohorts, the distinction between community-acquired and hospital-acquired AKI, and the central role of lung-kidney crosstalk in patients with ARDS. Particular emphasis is placed on the impact of mechanical ventilation strategies, especially driving pressure and reduced lung compliance, as key determinants of adverse kidney outcomes. We also review the role of urinary biomarkers for early detection of kidney injury and a stage-based management approach that includes conventional kidney replacement therapies and adjunctive extracorporeal support strategies. The INER experience highlights the importance of early nephrology involvement in the care of critically ill patients and the generation of local evidence to improve kidney-related outcomes in COVID-19.