Introduction: Renal involvement occurs in 40-60% of adults with leptospirosis and accounts for approximately 22% of deaths. It is a significant risk factor for pulmonary haemorrhages. The data for children are limited due to sparsity of cases. Objective: To assess the patterns of renal involvement and its clinical associations in children with leptospirosis. Methodology: The retrospective observational study included children with serologically confirmed leptospirosis and renal involvement admitted to Paediatric Nephrology unit at National Hospital, Galle, between 2021 and 2026. Results: Fifteen patients presented at 4.2±1.2days of illness with renal involvement. The mean age was11.4±1.7years with male predominance (80%). At presentation, 40% were in AKIN 3(