Introduction and importance: Bladder stones constitute approximately 5 % of all urinary tract stones. A giant bladder stone weighing >100 g and a diameter of >4 cm is a rare finding. Bladder stones are more common in adult males. Giant bladder stones are a rare entity in western practice, and are usually associated with bladder outlet obstruction, urinary tract infections, or the presence of intravesical foreign bodies and are rarely associ-ated with renal failure.Case presentation: A 25-year-old Ethiopian male patient presented with facial puffiness of two weeks duration which worsened early in the morning. He had a history of recurrent suprapubic pain, and straining during urination. On examination, he had a tender suprapubic mass. Investigations showed bilateral hydronephrosis and renal failure. Subsequently, the patient was diagnosed with a huge bladder stone with acute renal failure. Later, the stone was surgically removed and the patient was discharged improved.Clinical discussion: Risk factors for the development of bladder stones consist of bladder outlet obstruction, neurogenic bladder, chronic bacteriuria, presence of intravesical foreign substances, bladder diverticula, and rarely, upper urinary tract stone. Recurrent urinary tract infections, urinary retention, and hematuria are common signs of this disorder and rarely cause a renal failure like our patient.Conclusion: A giant bladder stone is a rare disease in modern urology clinical practice. Despite its rarity, giant bladder stone can cause acute renal failure and needs more attention. A comprehensive clinical assessment and thorough investigation are required during the evaluation of this kind of patient to prevent misdiagnosis and to ensure prompt treatment.