At the age of 8 years, he looked well, with normal intellectual ability, but 1 year delayed bone age. His body weight was 24 kg, and height was 118 cm (25th percentile). Abdominal and pelvic ultrasound of all organs was normal, except for kidneys. Both kidneys were of normal size, but with increased echotexture, more pronounced on the right side. The right kidney measured 8.2 cm and the left one was 8.1 cm. The bladder was unremarkable. These findings were suggestive of early changes of chronic kidney disease. All other investigations were normal such as eye and brain CT scan. A few months later, his investigations showed Urea Nitrogen blood (BUN) of 27 mmol/L,serum creatinine of 547 lmol/L, serum calcium of 4.09 mm/l and phosphorus of 0.56 mmol/L. Unfortunately, his condition deteriorated rapidly; his renal function was impaired, having uraemia, hyper-phosphatemia, anaemia (Hb 7 g/L) and hypertension, which then progressed to ESRD in a very short period. Initially, he was managed with standard medical anti failure treatment and dialysis, then underwent pre-emptivecadaveric renal transplant few months later.