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Kidney failure is a known complication of hematologic malignancy. Common causes include direct parenchymal infiltration by leukemic cells, intrarenal leukostasis, tumor lysis syndrome, Fanconi syndrome, cryoglobulinemia, paraprotein deposition disease, obstruction, and chemotherapy-induced tubular or vascular toxicity. 1 Although these causes of kidney injury are well characterized, other less common causes of malignancy-associated kidney disease exist. These may be poorly recognized because they have been less frequently reported. We present a patient with chronic myelomonocytic leukemia (CMML) who developed an unusual kidney complication of his malignancy. The cause of his decreased kidney function was diagnosed only after performing kidney biopsy.