REN and acute respiratory distress syndrome: Specifically, high positive end-expiratory pressure used for COVID-19 associated ARDS leads to increased intrathoracic pressure and can ultimately result in increased renal venous pressure and reduced filtration.42 Besides, positive pressure ventilation can increase sympathetic tone, leading to secondary activation of the renin–angiotensin system.43 Furthermore, upregulation of proinflammatory mediators associated to biotrauma, may subsequently induce multiple system organ failure including the kidney.