A 63-year-old man with a history of nephrolithiasis and neurogenic bladder requiring chronic indwelling urinary catheter was admitted for the management of urinary tract infection and acute kidney injury (AKI) with a serum creatinine level of 3.6 mg/dL (baseline approximately 1.9-2.2). He was initially brought to the emergency room for altered mental status. The patient was afebrile, but laboratory studies were significant for leukocytosis and pyuria. Bedside renal sonogram did not demonstrate hydronephrosis or nephrolithiasis (Figures 1A and B).