Focal Segmental Glomerulosclerosis is a common cause of glomerular disease in adults and can often lead to end stage renal disease if left untreated. It is characterized mainly by podocyte injury with effacement of foot processes. We present a case of a 40-year-old nulligravid female who was admitted for abnormal uterine bleeding and sepsis secondary to pneumonia. She developed sudden onset anuria and renal failure, which led to maintenance hemodialysis. Initial impression was acute kidney injury secondary to renal vein thrombosis. The impression was based on the finding of renal cortical necrosis evident on contrast enhanced computed tomography scan. There was no evidence though of disseminated intravascular coagulation and of a possible autoimmune disease in this case. Cortical necrosis can be attributed to the release of endothelin-1, a potent vasoconstrictor, which initiates endothelial injury with development of intravascular thrombosis and decreased renal perfusion leading to cortical necrosis in sepsis. Kidney biopsy of the patient, however, revealed a diagnosis of focal segmental sclerosis.