INTRODUCTIONPickering Syndrome is recurrent flash pulmonary edema affecting patients with hypertension and bilateral renal artery stenosis (RAS) or significant unilateral stenosis in a single functioning kidney and impaired renal function.1 Flash pulmonary edema (FPE) is a general term used to describe a hyper-acute presentation of decompensated heart failure due to an acute rise in left ventricular end diastolic pressure.2 However, Pickering Syndrome differs from the usual causes of left ventricular failure with pulmonary edema as this condition is not associated with left ventricular systolic dysfunction.3We report the case of a 43-year-old male with bilateral renal artery stenosis who developed recurrent episodes of severe pulmonary edema requiring mechanical ventilation in the background of resistant hypertension and CKD. The patient was scheduled for bilateral renal artery stenting but died 2 days after right renal artery stenting. Pulmonary edema is a common presentation among patients in the Emergency Department. In addition to cardiac causes, renal artery stenosis can also be a cause that may be missed in our setting.