Bile cast nephropathy is an often overlooked condition of acute renal injury in the setting of high serum bilirubin. While the exact pathophysiology remains unknown, possible mechanisms of renal injury are tubular obstruction from bile casts, direct toxicity from bile acids, and decreased renal perfusion due to hemodynamic changes. We present a patient with hyperbilirubinemia as a result of common bile duct obstruction due to pancreatic adenocarcinoma who developed anuric acute renal injury. Urine analysis showed bile casts that were highly suggestive for bile cast nephropathy. The patient underwent hemodialysis and bile drainage with full restoration of renal function.