A case is described of a 30-year-old woman with scleroderma renal crisis. She presented with classical symptoms: malignant hypertension of sudden onset and rapidly progressive renal failure. End-stage renal failure developed in spite of treatment with angiotensin converting enzyme inhibitors and the patient became dialysis-dependent. Five years later her condition was still stable. She lived in a nursing home, severely disabled but mentally healthy. A renal crisis is one of the most life threatening complications of scleroderma. By immediate treatment with ACE inhibitors, dependence on haemodialysis can be prevented in half the patients.