Atherosclerotic renal artery stenosis (RAS) is a well-known cause of secondary hypertension and progressive renal insufficiency. In patients with a solitary functioning kidney, it is uncommon but high-risk, posing a dilemma between revascularization and medical management. Revascularization is usually reserved for selected high-risk cases. We report a 54-year-old woman with hypertension, prior ischemic heart disease, superficially invasive squamous cell carcinoma of the cervix, and a solitary functional kidney, who was admitted with acute renal failure and recurrent episodes of flash pulmonary edema. CT angiography revealed occlusion of the left renal artery and severe stenosis of the right. Angioplasty and stent placement in the left renal artery restored blood flow, leading to recovery of renal function and adequate blood pressure control. Renal revascularization can improve blood pressure, renal function, and cardiovascular profile. Despite trials such as STAR, ASTRAL, and CORAL not showing overall benefit over medical therapy, international guidelines recommend considering revascularization in selected high-risk patients. This case illustrates that endovascular revascularization can be effective in patients with a solitary kidney and severe RAS, emphasizing the importance of a multidisciplinary, individualized approach to optimize clinical outcomes.