BACKGROUND:Acute renal failure (ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive. METHODS:We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy (SWL) for dissolution of calculi. RESULTS:The patient was successfully treated, and reported asymptomatic in a follow-up. CONCLUSION:Close collaboration between nephrological, urological, and radiological services is required.