"Introduction. Prostate cancer is currently the second most frequent malignancy in males with nearly 1.4 million new cases every year. Hematuria, hemospermia, discomfort in the hypogastrium, urinary incontinence and incomplete evacuation of the bladder are some of the non-specific symptoms it associates. Acute kidney injury is a rapidly progressive form of renal dysfunction, most frequently associated with serum nitrogen by-product retention, electrolyte disturbances, a decreased total urinary output and numerous and diverse ethiologies. Case presentation. An 83-year-old male witsh severral preexisting cardiovascular and gastrointestinal disorders presented to the emergency department for hypogastric pain with no specific irradiation or apparent relation with meals or body posture. The blood tests revealed metabolic acidosis, leukocytosis, moderate anemia, and nitrogen by-products retention and Abdominal ultrasound confirmed an enlarged, prostate and a series of simple renal and hepatic cysts. antibiotic treatment and hydro-electrolytic rebalancing therapy were initiated but, as the clinical evolution was declining, the patient underwent a computed tomography (CT) scan that revealed ureterohydronephrosis, a large periaortic adenopathic block and a severe circumferential thickening of the colonic wall. After rulling out colorectal neoplasia the patient was transferred to the surgery department, where a bilateral double-J stent was placed, and a prostate biopsy was performed. The prostate biopsy result was that of a poorly differentiated acinar adenocarcinoma with a Gleason score of 9 (4 + 5) and the patient was discharged approximately four days after surgery and referred to the urology department for treatment. The peculiarity of this case is the concomitant presence of a parietal circumferential thickening located in the recto-sigmoid and a significant abdominal lymphadenopathy. Large abdominal adenopathy is some of the most atypical prostate cancer presentations. Conclusion. Acute kidney injury is a rapidly evolving syndrome that needs a complete evaluation and close follow-up for a correct diagnosis."