Evans syndrome (ES) is a rare autoimmune disorder whose exact pathophysiology is 
unknown. It is characterized by the simultaneous or subsequent development of 
autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). 
Intravascular hemolysis, with hemoglobinemia, is known to produce acute kidney 
injury; however, the development of intratubular hemoglobin casts (hemoglobin 
cast nephropathy) in the setting of acute hemolysis is uncommon. Likewise, the 
association of ES and acute renal failure is equally uncommon. We present a case 
of a 7-year-old girl with ES who developed acute kidney injury in the setting of 
intravascular hemolysis and had widespread intratubular hemoglobin casts.