Background: Renal diseases are major causes of morbidity and mortality in hospitalized pediatric patients. More than half of patients with advanced kidney disease do not receive any treatment, especially in the low and low middle income countries. The patterns of renal disease in children are different in developing countries as compared to developed countries and pediatric renal diseases contribute about 3.5-8.9% of total pediatric admissions. Data on the spectrum of renal disorders in African children are scanty especially in Bahirdar. Objective: The objective of this study was assessing pattern, outcome and associated factors of renal disease among pediatrics renal patients in hospitalized children beyond neonatal age at TGSH and FHCSH from January 1/2019 to August 30/2020 Methods: Institution based cross sectional study was conducted over 19 months in 107 patients who fulfilled the eligibility criteria from TGSH and FHCSH. Data collected by checklist was entered, cleaned and analyzed by SPSS statistical software version 23. Descriptive and summary statistics was carried out. Chi-squared test was used to assess the association between dependent and independent variable. Result. From a total of 107 renal patients 55.1% were males and most patients are from rural areas ( 83.2%) and from FHCSH (56.1%). The majority of patients are in age 5-10 years (46.7%). Glomeluronephritis was the most common causes of renal admission (59.8%) and 40% of these patients had renal failure. Most patients (87.98%) discharged improved including referrals and 12.1% of patients died because of multi-organ failure and sepsis. Twenty five patients (23.4%) needs renal replacement therapy and no patient received this therapy including the deaths. AKI, CKD, complications ( sepsis,multi-organ failure)hospital stay >2weeks, electrolyte abnormalities ,decreased UOP ,seizure or decreased mentation had associations with outcome of patients with renal disease. Conclusion: From a total of 107 renal patients most patients were from rural areas and males. Glomeluronephritis was the most common causes of renal admissions. Most patients were discharged improved including referrals. Sepsis and multi-organ failure are the most common cause of death. The presence of complications (sepsis, multi-organ failure), hospital stay >2weeks,electrolyte abnormality, seizure or decreased mentation had associations with outcome of patients with renal disease. Key words: pattern, outcome, associated factors, renal disease, pediatrics, Bahirdar