A 24-year-old female patient with history of epilepsy, depression, and chronic kidney disease (CKD) of unknown etiology presented to the emergency department for suicidal ideation and was incidentally found to have a creatinine of 6.24 mg/dL. Her serum creatinine level 6 months prior to presentation was 1.6-1.9 mg/dL and was normal 3 years beforehand. In the emergency department, her creatinine improved only marginally with fluids. Her medications were as-needed acyclovir for herpes simplex virus flares and acetaminophen for pain; she had a remote history of occasional nonsteroidal anti-inflammatory drug use but reported no excessive use and none recently.