Background and Purpose: Severe acute respiratory syndrome (SARS) is caused by a new coronavirus, and results in respiratory failure. Acute renal failure (ARF) may also occur and/or complicate the disease course, however, its incidence, causes and impact in SARS patients are not known. Methods: ARF patients were identified from a total of 78 (33 men and 45 women) probable SARS cases admitted to a single hospital. The clinical features of patients with ARF were characterized, and the etiologies analyzed. Results: Patients were assigned to ARF (n=13; 17%) and non-ARE groups (n=65). Patients with ARF were older than their non-ARF counterparts. ARF developed 7.2±4.3 days after admission. The incidence of ARF was higher in males (77% vs 35%; p<0.05). Comorbidities of diabetes and heart failure were more common in patients who developed ARE (38% vs 6%, p<0.01 and 38% vs 2%, p<0.001, respectively) and the incidence of respiratory failure (85% vs 26%, p<0.001) and mortality (77% vs 8%, p<0.001) were also higher. Multiple organ system failure usually accompanied ARF. Hypotension (77%) caused by nosocomial infections, gastrointestinal bleeding, or SARS per se, and rhabdomyolysis (43%) was associated with ARF in addition to pre-renal factors. Five patients in the ARF group and 1 female patient with end-stage renal failure underwent renal replacement therapy during hospitalization; however, both eventually died. Of the 16 medical staff performing renal replacement therapy, none was subsequently infected with SARS coronavirus. Conclusions: Development of ARF during the disease course in SARS patients is associated with catastrophic outcome. The cause of ARF in SARS patients is often associated with pre-renal factors, hypotension, rhabdomyolysis, and previous comorbidities including diabetes and old age. Universal precautions to prevent viral transmission are mandatory for medical staff performing renal replacement therapy.