The morphologic changes that are seen in classic ischemic and toxic acute tubular necrosis are often lacking [5],[6] or are microscopically distinct in septic AKI [7],[8]. While the use of renal biopsy in the management of septic AKI is exceedingly rare in many western nations, most human studies have found no consistent histopathologic changes in septic AKI, and acute tubular necrosis is infrequently observed [5],[6]. In a systematic review of six studies describing histopathologic changes seen in septic AKI, Langenberg and colleagues [6] found that tubular epithelial cell necrosis was seen in only 22% of human samples taken after septic injury. A more recent study by Takasu and colleagues [8] examined post-mortem kidneys taken from 67 patients who died with sepsis, and while they found focal tubular injury in 78% of septic kidneys, the majority of tubular cells were normal.