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0 �� 5.4cms and left kidney 10.5 �� 4.5cms with bilateral normal echogenicity and normal corticomedullary differentiation. There was no evidence of calculi or hydronephrosis. A renal biopsy was planned on the initial day of admission but was deferred due to high blood pressure. She was initiated on antihypertensive medications including nitroglycerine infusion. Her blood pressure was [http://www.selleckchem.com/products/plerixafor-8hcl-db06809.html click here] controlled on second day and renal biopsy was done which revealed nine glomeruli of which four were obsolescent. The obsolescent glomeruli were small and globally sclerotic. Viable glomeruli were near normal in size and cellularity. Peripheral capillary loops appeared delicate and one glomerulus revealed simplified tuft with wrinkled capillary loops. Tubules showed simplification and vacuolation of epithelium and polarising crystals with fractured glass appearance in the lumen, morphology of which was suggestive of calcium oxalate (Figure 3(a)). Some of the tubules revealed epithelial calcification. There were thin strips of atrophic tubules amounted to around ten % of the cortex. Interstitium showed patchy edema and mild mononuclear infiltrate especially around the atrophic glomeruli and tubules. There was no significant interstitial fibrosis. Large calibre artery showed mild intimal fibroplasia. Interlobular artery revealed medial hypertrophy and arterioles showed hyperplastic change. Immunofluorescence studies were negative for IgG, IgA, IgM, C3, C1q, and both kappa and lambda light chains. A [http://www.selleckchem.com/products/gant61.html GANT61 manufacturer] histological diagnosis of acute tubular injury associated with calcium oxalate crystals in a background of mild global glomerulosclerosis and hypertensive vascular changes was made. Patient was managed conservatively as she was nonoliguric. Her renal function initially showed progressive worsening and serum creatinine reached up to 4.9mg %. She also had high blood pressure which required usage of multiple antihypertensive drugs including amlodipine, atenolol, clonidine, prazosin, telmisartan, minoxidil, and nitroglycerine. Her renal functions gradually improved and blood pressure improved. She was discharged ten days later with serum creatinine of 1.4mg/dL and three antihypertensive drugs (amlodipine, atenolol, and clonidine). Figure 2 Calcium oxalate crystals in urine in high power view. Figure 3 Renal biopsy specimen (40X) with arrow showing calcium [http://en.wikipedia.org/wiki/Phosphorylase Phosphorylase] oxalate crystals. Table 1 Laboratory investigations at admission to hospital. 3. Case 2 A forty-seven-year-old male presented with nausea, vomiting, and generalized edema of three-day duration. He had decreased urine output (