The patient is a 34-year-old gentleman with end-stage renal disease secondary to polycystic kidney disease. He had recently started hemodialysis and has recently undergone bilateral native nephrectomies and cholecystectomy. His history is significant for right infected renal cyst drained in the remote past. Most recently, he had a left infected cyst drained. Symptoms of his polycystic renal disease included early satiety, and occasional heartburn. He felt that his left kidney had been growing progressively, and that caused him discomfort. He was known to have gallstones by a CT scan that was performed at an earlier date to evaluate his cyst. He did not give any history of fatty food intolerance or pain specifically in his right upper quadrant. Given the size of the right kidney and some cysts in his liver, it was difficult to tell whether the discomfort was due to gallstones or his kidney cyst so he underwent cholecystectomy at the same time as his renal surgery. Of note is that he has reasonably high blood pressure. He runs diastolic pressures over 100 or 105 routinely. He is, however, only on 1 medication for that (Norvasc). He had a recent MRI that showed no aneurysms in the cerebral circulation.

	Right kidney surface
	Left kidney surface
	Cut surface of kidney
	Microscopic view at low power of the cysts:

1.What is your diagnosis?