Nephrolithiasis in patients with a solitary kidney can cause obstructive anuria. However, to our knowledge we report the first case of renal artery bypass graft thrombosis after acute ureteral obstruction in a solitary functioning kidney presenting with anuria. We propose that myogenically mediated renal artery hypoperfusion secondary to acute ureteral obstruction, with blood pooling at the renal artery anastomotic site of a previous abdominal aortic aneurysm repair, was responsible for the thrombotic event. Physiological evidence concerning renal artery hemodynamics in acute ureteral obstruction is reviewed.