This 39-year-old male had malignant hypertension with malignant nephrosclerosis, progressing to chronic renal failure. He underwent a bilateral nephrectomy for control of his hypertension and received a cadaveric renal transplant. He did well, although he developed diabetes mellitus and had persistent, but less severe controllable hypertension. Two years following transplantation he was admitted to the hospital for control of his hypertension and evaluation of his chronic rejection. Initial blood bllod pressure while in the hospital was in the range of 160/110 to 160/100 mm Hg. He was placed on a more intensive hypertension regimen, elevated and he gradually became normotensive. He received one hemodialysis treatment prior to discharge. At the time of discharge, his blood pressure was 100 to 110 over 60 to 70 and he was doing well on dialysis. His BUN was 113 mg/dL and creatinine 5were gradually rising despite aggressive treatment.2 mg/dL, A transplant nephrectomy was performed 4 years after his transplant and he had a hematocrit (PCV) of 27%resumed hemodialysis.  The patient was again admitted one month later for evaluation of azotemia kidney weighed 125 grams and for control of his hypertension. It was felt that his chronic rejection covered by a thick capsule, which was end-stage and that he would have partially adherent to the cortex, but could be dialyzed periodicallystripped from the kidney with slight difficulty. He The cortex was put on a renal failure diet, thinned but calyces and over pelvis of the period of his hospitalization, his BUN and creatinine finally stabilized at high levelskidney appeared normal. He tolerated dialysis well, and a transplant nephrectomy was done at 2 1/2 years post transplantThe vessels were not prominent. At the time of discharge, the patient's BUN was 78 mg/dL, creatinine 3.6 mg/dL, WBC 5000 cells/mm³, The renal arteries and the PCV was 26%vein appeared normal.