Generalized
arterial calcification of infancy (
GACI) is a rare condition characterized by diffuse arterial calcification within the internal elastic lamina associated with intimal proliferation leading to
stenosis of great and medium-sized vessels, which causes end-organ damage and loss of life during infancy. The clinical presentation of
acute renal failure with normal cardiac function is rare. A 7-day-old female neonate was admitted with a clinical impression of late-onset
neonatal sepsis,
meningitis, and
acute kidney injury after developing a high-grade
fever, abnormal body movements, and
vomiting of the ingested matter associated with decreased urinary output. On laboratory tests, she had abnormal
urea and
creatinine levels, multiple
electrolyte abnormalities, and a negative septic workup. Ultrasonography revealed diffuse arterial calcification that also involved the renal arteries and renal parenchyma bilaterally. She was clinically diagnosed with
GACI and initiated on supportive care including
renal replacement therapy. However, she died at the age of 42 days. This case highlights that
GACI can present as unexplained
acute kidney injury associated with generalized arterial calcification. Ultrasound can be optimized to aid in diagnosis in resource-limited settings.