Nephrogenic ascites is a rare occurrence with an extremely low incidence. It is easily misdiagnosed by both emergency physicians and nephrologists. Missed diagnosis contributes to a significant increase in morbidity and mortality. We report a case of nephrogenic ascites presenting and diagnosed in the emergency department by confirming lack of alternative diagnoses coupled with point of care ultrasound of the abdomen and CT scan abdomen and pelvis. Familiarity with this rare complication of end-stage renal disease is important for emergency physicians, as the mortality rate is very high. Early recognition, diagnosis, and treatment has been demonstrated to substantially reduce morbidity and mortality.