A 53-year-old male known with HIV infection since 2010 was admitted to hospital in April 2014 with symptoms of vomiting and abdominal pains for three days prior. It was associated with nausea and the vomitus contained food, was non-blood stained and occurred 3-4 times a day. He also complained of dizziness, some cough and had recently noted that his urine output had reduced without change in colour. He however had no history of diarrhoea or fever. He had been started on first line drugs; zidovudine (AZT), 3TC and EFV in 2010 and also put on cotrimoxazole prophylaxis of 960mg daily. He had a history of tuberculosis treatment the same year, for which he completed medication. In 2012, he was switched to second line treatment of ritonavir-boosted lopinavir (LPV/r), 3TC and TDF due to drug failure. His most recent viral load in 2013 was undetectable. On admission, he was very pale with oral thrush, was severely wasted and volume depleted; and had no oedema. His blood pressure was 100/60 and temperature 36.1 degrees. His systemic exam was otherwise unremarkable. Laboratory tests revealed the following: white cell count of 2,350/mul, hemoglobin of 3.8g/dL and a platelet count of 353,000/mul. Creatinine was 559mumol/l, urea 55mmol/l, potassium 4.5mmol/l and sodium of 114mmol/l. He had hepatitis B surface antigen positivity. He was put on antibiotics, fluconazole, rehydrated and transfused. TDF was discontinued and replaced by ABC, 3TC was renal dosed, LPV/r continued and cotrimoxazole dose halved. On the third day, the creatinine level was 541mumol/l, urea 35mmol/l, potassium 2.5mmol/l, chloride 86mmol/l and sodium122mmol/l. He was managed for hypokalemia. Over the next few days the creatinine levels reduced progressively and at discharge the creatinine level was down to 216mumol/l and urea to 33mmol/l. He was followed up and a month later, his renal function had normalized.