Scleroderma renal crisis is one of those conditions that is rare enough to be missed, but dangerous enough that missing it is simply not an option. A feared complication of systemic sclerosis, it typically occurs in patients with rapidly progressive skin disease and may present dramatically with malignant hypertension and an abrupt decline in renal function. Before the advent of ACE inhibitors, outcomes were dismal. While prognosis has improved substantially, SRC remains a life-threatening emergency with important long-term renal consequences, including prolonged dialysis dependence in some patients. Early recognition of those at highest risk, together with prompt initiation of appropriate therapy, remains central to improving outcomes. This promises to be an excellent MDT discussion on a condition where timely diagnosis can make all the difference.