Hiccups are usually benign processes that most people experience with spontaneous resolution. However, persistent hiccups with a duration greater than 48 h may prompt a thorough workup for structural, infectious, or inflammatory disorders. Moreover, toxic-metabolic states, including renal dysfunction and/or uremia, have also been identified as sources of hiccups. We present a 62-year-old male with persistent hiccups that developed acute, worsening renal function. Workup for a possible intrinsic renal disease process was negative. Ultimately, a kidney biopsy was performed, demonstrating acute tubular injury with oxalate crystals and interstitial fibrosis. Dialysis was initiated with resolution of the hiccups, and kidney function improved over an extended period of time.