Our appreciation is extended to Dr. Abdul Abid, University of Texas Medical Branch, for contributing this case.

History: A 55-year-old man presented with back pain and hematuria. He developed hypertension 10 years ago and it is now uncontrolled. He has had previous episodes of pelvic pain. Imaging revealed large kidneys bilaterally. Due to his declining kidney function, a kidney transplant was recommended, and he underwent a bilateral nephrectomy. Gross and microscopic images are presented.

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