Presentation with a microangiopathic blood picture with acute renal impairment in keeping with CM-HUS. Treatment is initiated with supportive care and possibly complement inhibitor therapy. Confirmation using standard genomic platforms, including exome sequencing or NGS, may take weeks or months. Using nanopore sequencing, the results may be available in hours to days, aiding the rationale to initiate therapy. CM-HUS, complement-mediated hemolytic uremic syndrome; NGS, next generation sequencing.