A renal biopsy had been recommended for patient 6159 during her ICU admission as part of her diagnostic workup for acute renal failure, but once rWGS revealed a likely pathogenic variant in COL4A4, associated with Alport syndrome/thin basement membrane nephropathy (OMIM#141200; thin-basement-membrane nephropathy), the nephrologist canceled plans for the biopsy. This evidence concerns the gene COL4A4 and acute kidney injury.