Acquired renal cystic disease (ARCD) is a pathological condition occurring in patients undergoing hemodialysis. While often asymptomatic, these patients may present serious complications such as pain, hematuria, renal enlargement, massive hemorrhage and development of renal cell carcinoma. It is known that renal transplantation (RT) may delay the progression of the acquired cysts or even make them regress. However, although rare, severe complications may occur, as is reported in this case of acute severe bleeding 5 years after RT.