The common factors that cause retrograde renal failure are: 1. tumorigenic factors, including rectal cancer, primary retroperitoneal tumor, lymphoma, primary urinary pelvis and ureteral tumor, etc.; 2. non-tumorigenic factors, including foreign bodies (stones, blood clots, etc.), tuberculosis, inflammation, trauma and various urinary tract malformations and other urological diseases, pregnancy, retroperitoneal tuberculosis, retroperitoneal fibrosis, and medically induced injuries, among which upper urinary tract stone obstruction, especially bilateral upper urinary tract stone obstruction, is a common cause of renal failure. Upper urinary tract stones cause urinary tract obstruction, resulting in different degrees of hydronephrosis, impaired excretion of metabolites, azotemia, water-electrolyte and acid-base balance disorders, and even uremic toxicity, which is life-threatening. Early renal blood flow (RBF) after acute upper urinary tract obstruction shows characteristic three-stage changes: in the first stage about 3 h, renal pelvic pressure rises, small inlet arteries expand, and RBF increases; in the second stage, when renal pelvic pressure rises further after obstruction for 5 h, small outlet arteries appear to contract in response, and RBF gradually decreases; in the third stage, renal pelvic pressure begins to fall after 5 h of obstruction, at which time, due to human small arteries contracted, RBF returned to baseline and progressively decreased. The renal hemodynamic changes in the early phase of obstruction may be mediated by local myogenic factors. The increase in renal pelvic pressure and activation of the renin-angiotensin system reduce renal blood flow, which leads to a dramatic decrease in glomerular filtration rate and isotonic reabsorption of the renal tubules, etc. When upper urinary tract obstruction occurs, the pressure in the proximal ureter, renal pelvis, interstitial tubules and collecting ducts of the obstruction increases progressively, and the intracapsular pressure in the renal tubules and glomeruli also rises continuously. The pressure in the proximal tubule and distal tubule was 4 kPa and 3.7 kPa respectively at 24 hours of obstruction, resulting in ischemia of the glomerulus, especially the tubule, and the increased pressure in the renal pelvis also directly compressed the small blood vessels in the kidney, increasing their resistance and causing ischemic damage to the kidney. Upper urinary tract obstruction can have a serious impact on renal function within a short period of time, and the duration of obstruction is closely related to the recovery of renal function. 24 hours after lifting the obstruction, blood flow can be restored to 50% (or 30%-60%) of the control group, while organic changes take longer to recover. Valery et al. concluded that 89% of renal function in patients with acute obstructive renal failure is reversible. Other data show that for those who are released after 36 hours of obstruction, the glomerular filtration rate and tubular function are expected to be fully restored, for those who have been obstructed for more than 2 weeks, 45% to 50% can be restored, for those who have been obstructed for 3-4 weeks, 15% to 30% can be restored, and for those who have been obstructed for more than 6 weeks, it is difficult to be restored. Upper urinary tract obstruction can rapidly lead to azotemia and disturbance of water, electrolyte and acid-base balance due to impaired excretion of metabolites. In patients with water intoxication, hyperkalemia, metabolic acidosis and systemic toxicity caused by a series of nitrogen metabolites storage, giving necessary medical and hemodialysis treatment can increase the safety of the procedure. However, overemphasis on medical and hemodialysis treatment and repeated use of diuretics may increase the pressure in the renal pelvis before the obstruction is relieved, leading to glomerular ischemia and hypoxia and accelerating renal function damage. Multiple hemodialysis sessions may also aggravate infection and damage the renal parenchyma and complicate dialysis imbalance syndrome. In our group, there were three patients who were repeatedly treated with diuretics in outside hospitals before consultation, resulting in less and less urine output, more and more severe acidosis and water and electrolyte disorders, and their condition was improved only after percutaneous nephrostomy and drainage. The principle of treatment for upper urinary tract obstruction is to remove the obstruction as soon as possible to maximize the protection and restoration of renal function. The traditional treatment method is open surgery or cystoscopic drainage of the ureter with an indwelling catheter to relieve the obstruction. With the development of endoluminal technology and the accumulation of experience in endoscopic operation, stone upper urinary tract obstruction is more likely to be treated by minimally invasive techniques. For acute upper urinary tract obstruction and more severe cases, we use ureteral placement for drainage or percutaneous nephrostomy, and further treatment will be done after the condition is stabilized. The purpose of ureteral drainage is to provide temporary drainage and to facilitate the discharge of stones after extracorporeal shock wave lithotripsy (ESWL) to prevent the formation of “stone streets” that can cause obstruction again. Percutaneous nephrostomy is a minimally invasive, highly effective and successful drainage procedure that not only effectively drains urine, but also provides access for second-stage surgery. Ureteral placement drainage is simpler and less expensive than percutaneous nephrostomy and is suitable for primary hospitals; percutaneous nephrostomy should be preferred for critically ill upper ureteral stones and multiple renal ureteral stones. In our group of 32 patients with acute renal failure due to upper urinary tract stones, ureteral placement or percutaneous nephrostomy under local anesthesia was performed, and the blood creatinine decreased significantly, and further treatment was performed after the patients’ renal function recovered and their physical condition improved. For those with short duration of disease, light poisoning and good physical condition, ureteroscopic lithotomy is feasible. In recent years, with the continuous improvement of ureteroscopy and the application of holmium laser in lithotripsy treatment, ureteroscopic endoluminal treatment technology has been increasingly improved, which has the advantages of less trauma, high success rate of one-time lithotripsy, less complications, and fast recovery of patients, etc. Moreover, for negative stones in the middle ureter, when the effect of B-ultrasound examination is not good and CT cannot be determined, ureteroscopy can be performed directly, and holmium laser lithotripsy can be performed directly after clarifying the stones. Watterson et al. reported that retrograde ureteroscopy with pneumatic ballast lithotripsy, holmium laser lithotripsy or YAG laser lithotripsy was safe and effective. In our group of 36 patients, Holmium laser lithotripsy under ureteroscopy was used to relieve the obstruction with satisfactory results. Ureteroscopic lithotomy is suitable for middle and lower ureteral stones, for those who have difficulty in locating ESWL or failed treatment, for those who have formed stone streets after ESWL, and for a few upper ureteral stones with relatively low location. For larger upper ureteral stones, because the stones are closer to the renal pelvis and can easily return to the kidney, percutaneous nephrolithotomy can be used to completely remove the stones. Percutaneous nephrolithotomy provides good conditions for surgery because of the small puncture channel, less bleeding, and mild trauma, and it can be used for multiple stone fragmentation to reduce the impact of surgery on renal function. 83 patients with isolated kidney treated by PCNL were followed up by Liou et al. for an average of 4.3 years and up to 14 years, and no damage to renal function was found. Using percutaneous nephrolithotomy to treat upper urinary tract stones with combined acute obstructive renal failure, our experience: 1. Single-channel stone extraction should be applied as much as possible to reduce the loss of renal units; 2. The puncture point should be chosen between the middle and upper renal calyces to facilitate reaching the upper ureter and as much of the calyx neck as possible; 3. The puncture should be accurately positioned and the surgical operation should be gentle to avoid tearing the calyces and causing intraoperative bleeding, which affects the surgical operation. We used percutaneous nephrolithotomy to treat renal ureteral stones, and the stone retrieval rate was 94% without serious complications. At this stage, with the improvement of surgical techniques and intracavitary instruments, minimally invasive techniques have become the main treatment for urolithiasis, especially in the management of acute obstructive renal failure due to upper urinary tract stones.