Case Presentation: 54 year-old female with past medical history of stage IV right renal cell carcinoma s/p nephrectomy and recurrent urinary tract infections secondary to left staghorn calculus was admitted for generalized weakness, fatigue, nausea, vomiting and altered mental status. Physical exam showed scleral icterus. Lab work was significant for elevated aminotransferases, bilirubin and alkaline [...]