A case report is presented, which describes a patient with a long history of stable but mild renal insufficiency for several years, who presented with end-stage stage renal disease following a rapid decline of renal function and accelerated hypertension. A renal work-up disclosed severe bilateral renal artery stenoses. A percutaneous transluminal renal angioplasty (PTRA) with stent significantly improved both renal function and hypertension and the patient was still not on dialysis twelve months after the procedure. The epidemiology, prognosis, diagnosis and treatment of the atherosclerotic renovascular disease are discussed. Treatment consists in the revascularization, this can improve not only the hypertension but also the renal function. In patients with end-stage renal disease PTRA can postpone for several months the need for dialysis.