We have described a case of malacoplakia presenting with uremia in a young, previously healthy black man. Malacoplakia was found in the bladder over both ureteral orifices, causing obstruction. The patient was treated with antibiotics, a percutaneous nephrostomy tube, and finally with transurethral resection of the malacoplakia over the ureteral orifices. The patient's renal function improved dramatically and he is presently asymptomatic.