Background There is growing evidence that acute respiratory distress syndrome (ARDS) can lead to renal complications including acute kidney injury (AKI), but the key factors that increase the risk of AKI occurrence in these patients need to be identified. The aim of this study was to assess the risk of AKI in ARDS and its effect on the outcome in patients admitted to ICUs at Zagazig University Hospitals. Patients and methods This study included 81 patients with ARDS, with age of 46.36±9.31 years (mean ±SD), from September 2017 to March 2019. During their admission, patients who developed AKI were identified; their clinical and laboratory data were evaluated and compared with AKI-free patients. Results A total of 31 (38.3%) patients among the studied patients with ARDS developed AKI. IV contrast, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, blood product transfusions, septic shock, higher age, higher BMI, presence of diabetes mellitus or heart failure comorbidities, increased acute physiologic and chronic health evaluation and sequential organ failure assessment scores, higher serum lactate, increased total bilirubin, and lower platelet counts were significantly higher in patients who developed AKI. Patients with ARDS who developed AKI had significant prolonged hospitalization and significantly higher hospital mortality. Conclusion The risk of AKI in patients with ARDS is high, and it is associated with a poor prognosis, and so it is essential to predict patients with ARDS who are at high risk for developing AKI to implement early strategies aiming to prevent AKI.