Atheromatous nephropathy, due to a reduction of arterial blood flow caused by stenosis or thrombosis of renal arteries, is now recognized as an important cause of chronic renal failure in the elderly. It has been shown that renal revascularization may allow a recovery of renal function up to the withdrawal of dialytic treatment. Digital arteriography is the preferred diagnostic method, but doppler scan and renal scintigraphy after administration of captopril may also prove useful, specially in the follow-up of the patients. Therapeutic means include percutaneous transluminal angioplasty and surgical revascularization; both treatments may improve or stabilize renal function. Surgery may allow better results in the long term, but is loaded by a significant morbidity. Our experience confirms the possibility to obtain a significant long term improvement of renal function after bilateral surgical revascularization.