Arsenic poisoning is an often unrecognized cause of renal insufficiency. We report a case of tubulointerstitial nephritis associated with an elevated urinary arsenic concentration. Removal of the putative source of arsenic resulted in symptomatic improvement, resolution of abnormal abdominal radiographs, and stabilization of renal function. This case emphasizes the importance of heavy metal screening in patients with multisystem complaints and tubulointerstitial nephritis.