PURPOSE To illustrate the benefits of treating severe renal artery stenosis in renally compromised patients prior to surgery for coronary artery disease. CASE REPORT A 63-year-old woman with unstable angina, severe coronary artery disease, and long-term severe renal impairment with a single functioning kidney underwent renal stent placement for high-grade renal artery stenosis prior to coronary artery surgery. The procedure improved her serum creatinine from 528 micromol/L at baseline to 385 micromol/L, and she subsequently underwent coronary artery bypass grafting without deterioration in her renal function. At 1 year, the patient has a serum creatinine of 400 micromol/L, and there is no evidence of in-stent stenosis. CONCLUSIONS Percutaneous renal angioplasty or stenting prior to coronary surgery in patients with concomitant renal and coronary artery disease may reduce perioperative renal deterioration in this specific group of patients.