Introduction: Acute kidney injury (AKI) has emerged as a common complication of COVID-19 pandemic affecting (17 - 37 %) hospitalized patients. But it is not clear whether COVID-19 influenced the epidemiology of AKI irrespective of the infectious status or not. Aim of the study: To cover AKI patterns during the pandemic. Methods: This retrospective cohort study was conducted on 50 pediatric patients diagnosed as AKI according to the p-RIFLE criteria, who were admitted at the Nephrology Unit, Pediatric Department, Tanta University Hospitals between January 2020 and June 2023. These patients were subjected to full history taking, full examination and laboratory investigations including (CBC, serum creatinine, urea, D-dimer, CRP, LDH, COVID-19 PCR), renal biopsy and radiological investigations (CT chest, MRI brain). Results: Among the studied patients, the average age was 5.5 years, with a male-to-female ratio (1.7:1.0). 70% of AKI patients required renal replacement therapy; the survival rate was 86%. At discharge, a significant improvement was noted in serum creatinine, hemoglobin, and platelet counts (p < 0.001). The median age of deceased patients (14%) was significantly lower (1.0 years) compared to survivors (7.0 years). Elevated D-dimer levels were observed in 100% of deceased patients, correlating with worse outcomes. Conclusions: This study revealed a significant increase in AKI incidence between pediatric patients during the COVID-19 pandemic, with poor outcomes in young female children (<5yrs) who had higher D-dimer levels.