HISTORY: The patient, female, 56 years old, with bilateral renal incompetence and uremia, had been undergoing routine hemodialysis for a long time in Shanghai First People’s Hospital. She presented with hypertension for 12 years, which worsened one year before the surgery, aggravated significantly with activity and cold weather, and her blood pressure was up to 260/180 mmHg, and arteriography revealed bilateral renal artery stenosis. Various medical-surgical and anesthesiological approaches were attempted, none of which were effective in controlling hypertension. Difficulties in treatment: The patient’s malignant hypertension (260/180 mmHg) could lead to hypertensive crisis, cerebrovascular accident, or even life-threatening condition at any time if surgery was not performed. However, the patient’s malignant hypertension, long-term hemodialysis, extremely low hematocrit (7.5g/L), and poor resistance with low leukocytes made the surgery extremely risky. Treatment process: After thorough pre-surgical preparation and communication with the family, under the multidisciplinary cooperation of anesthesiology, cardiology, nephrology, and hemodialysis, I performed laparoscopic nephrectomy for renal artery stenosis with non-functional nephrectomy under my own knife in September 2010, which was a smooth operation with an operating time of 1 hour and 30 minutes. The patient recovered quickly after the operation, and his blood pressure dropped to 190/150mmHg after 1 month, and was maintained at about 160/100mmHg after 3 months. Currently, his condition is stable. CONCLUSION: Laparoscopic nonfunctional nephrectomy for renal artery stenosis is an effective treatment for uremic patients with renal artery stenosis combined with hypertension if the malignant hypertension cannot be controlled by medical treatment. However, the surgery is extremely risky and requires multidisciplinary joint treatment preparation, and can only be performed after full communication with the patient and family.