eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2022-08-08 10 8 185 187 10.12691/ajmcr-10-8-1 AJMCR20221081 article Si Yuan Khor khorsiyu@msu.edu 1 Bo Ren Zhang 2 Sara AlAttal 2 Amira Kamboj 2 Richa Tikaria 2 Department of Internal Medicine, Michigan State University, Lansing, MI 48912, USA Department of Psychiatry, Michigan State University, Lansing, MI 48912, USA A 78-year-old female presented with chief complaints of nausea and vomiting for three days associated with generalized weakness and altered mental status. On examination, she was tachycardic and tachypneic with suprapubic distension and generalized tenderness with guarding. Urinalysis revealed urinary tract infection picture. Initial blood work showed leukocytosis, hyperkalemia, lactic acidosis, and acute kidney injury. CT Abdomen without contrast showed marked fluids surrounding the left kidney, bilateral hydronephrosis, and distended urinary bladder. She was treated with intravenous antibiotics and fluids for urosepsis secondary to complicated urinary tract infection with acute kidney injury due to obstructive uropathy. Follow-up renal ultrasound later revealed resolution of left perinephric fluids 3 days after alleviation of obstructive uropathy, thus suggesting a likely diagnosis of spontaneous left renal calyceal rupture. http://pubs.sciepub.com/ajmcr/10/8/1/ajmcr-10-8-1.pdf spontaneous renal calyceal rupture bladder outlet obstruction obstructive uropathy