Kidney malignant tumor with blood clots in urine may be renal pelvic cancer or tumor invading into renal collecting system, how to treat it should be based on imaging examination, combining with patient’s own state to choose surgery or targeted therapy. The most important symptom of renal pelvis cancer in early stage is painless hematuria, and a few patients may have lumbar discomfort, hidden pain and distension after the tumor blocks the renal pelvic ureteral junction, and occasionally renal colic may be caused by blood clot or tumor exfoliate. The treatment of renal pelvis cancer is still mainly based on surgery, removing the diseased kidney and the whole section of ureter including part of the bladder beside the opening of ureter, in order to prevent the tumor from reoccurring in the remaining ureter. Renal malignant tumor can present painless hematuria, which indicates that the kidney has invaded the collecting system, that is, invading the renal pelvis and calyces, and it is necessary to do the enhancement CT examination of kidney, if it is the early stage of renal carcinoma and the patient does not have contraindications to surgery, it is necessary to perform surgery as early as possible such as radical tumor necroplasty, in order to achieve the purpose of stopping the bleeding as soon as possible. If the patient’s kidney cancer has developed distant metastasis, or the patient’s own state is poor and can not tolerate surgery, he/she can consider doing genetic test and choosing targeted drug therapy under doctor’s guidance, and he/she can be treated symptomatically with some medicines to stop hemorrhage, for example, serpent venom hemagglutinin, tranexamic acid, etc. All the above medicines should be taken under doctor’s guidance. All of the above drugs need to be applied under the guidance of doctors. Once the renal malignant tumor has blood in urine, you should go to the hospital as soon as possible for examination and early treatment.