The results of treatment in patients with very advanced renovascular hypertension are presented. The patients were divided into two groups. In group one were patients with only one kidney and renovascular hypertension. The risk of operation and special precautions are discussed. Group two included patients with kidney non-function due to renal artery occlusion and severe hypertension. All these patients were candidates for nephrectomy. During the operation in some of them, the technical possibilities for vascular reconstruction were found. Instead of nephrectomy aortorenal bypasses were done.