Abstract Paroxysmal Nocturnal Hemoglobinuria (PNH) is an infrequent, acquired hematological disorder characterized by intravascular hemolysis and a spectrum of complications, including renal impairment. A 25-year-old male with established PNH presented with abdominal discomfort, emesis, dark-hued urine, and diminished urine output following substantial alcohol consumption. Laboratory investigations revealed severe anemia accompanied by a pronounced elevation in serum creatinine levels. Despite the implementation of supportive care, renal function deteriorated, necessitating hemodialysis. Renal biopsy demonstrated acute tubular injury with significant hemosiderin deposition. Following treatment with corticosteroids, dialysis, and blood transfusions, renal function was fully restored. This case underscores the peril of severe acute kidney injury in patients with PNH and accentuates the importance of renal biopsy in ambiguous clinical scenarios. It also prompts contemplation regarding the frequency with which acute kidney injury is overlooked in this patient population.