Atherosclerotic renovascular disease (ARVD) is a common manifestation of atheromatous disease. Whilst it usually displays a chronic and asymptomatic course, it is increasingly recognised as playing a significant pathophysiological role in a number of clinical presentations. Anuric acute renal failure (ARF), due to thrombotic renal artery occlusion (RAO) or progression to critical narrowing, however, is a rare complication of this. We report a patient who presented with anuric ARF and pulmonary oedema secondary to bilateral renal artery disease (one chronic RAO, one highly critical renal artery stenosis (RAS)). She showed a good response to renal revascularisation with restoration of renal function, even when this was performed after six days of anuria.