A 57-year-old man with a history of end-stage renal disease receiving intermittent hemodialysis secondary to polycystic kidney and liver disease presented with persistent cough that had increased in frequency and magnitude over the past 5 months. The cough was productive of whitish sputum, and was worse in the late afternoon. The patient complained of persistent fatigue from the severity of cough. The patient had previously received multiple courses of antibiotics with no relief. Sputum culture findings were negative. Chest radiography did not reveal any abnormality. CT scan of the chest was negative, as was a CT of the sinuses. Pulmonary function testing revealed mild restrictive lung disease, with a 17% decline in FVC from prior testing 18 months earlier. A medication review did not disclose any medications known to commonly cause cough. The patient had been maintained on a proton-pump inhibitor. He had a < 10 pack-year history of smoking, having quit many years earlier.