Wunderlich syndrome is a rare condition encountered in patients undergoing chronic hemodialysis (HD) usually attributed to acquired cystic kidney disease (ACKD) among other causes. However, presentation of renal hemorrhage after colonoscopy, to the best of our knowledge, has not been previously documented. Nevertheless, only splenic injury was rarely mentioned. Management can range from conservative treatment to angiographic embolization or exploration and nephrectomy. We report an unusual case of a 54-year-old woman HD patient who presented with SRH within a few days of colonoscopy. The reason of spontaneous renal hemorrhage (SRH) was rupture of a cyst of ACKD. We assumed that colonoscopy was a provoking factor and elaborated hypotheses for its etiopathogenesis. The patient underwent left successful nephrectomy. The importance of this case lies in the fact that colonoscopy is not 1 always an innocent procedure in HD patients, and could be complicated by renal cyst hemorrhage.