Objective To explore the imaging characteristics and diagnosis and treatment of spontaneous rupture and hemorrhage of renal tumor. Methods The clinical diagnosis and treatment data of 3 patients with spontaneous rupture and hemorrhage of renal tumor were retrospectively analyzed. 3 cases had no history of trauma and anticoagulant therapy, and all of them underwent ultrasound, CT examination, and 1 case of intravenous pyelogram. All were confirmed by postoperative pathology. RESULTS All 3 cases underwent open surgery, 1 case of radical nephrectomy for renal cancer, 1 case of partial nephrectomy, and another case of nephrectomy. One case was renal clear cell carcinoma and the other two cases were renal vascular smooth muscle tumor. Conclusion Spontaneous renal tumor rupture is a urological emergency, tumor rupture is more common in kidney, CT can accurately show the degree and site of bleeding, radical nephrectomy should be performed for renal cancer rupture and bleeding, and renal vascular smooth muscle tumor should be operated with preservation of renal unit. Spontaneous renal rupture is a urologic emergency, which usually refers to perinephric, subdorsal renal, and retroperitoneal hemorrhage caused by non-traumatic rupture of the kidney itself. Although clinically rare, it is challenging to diagnose and treat. Spontaneous renal rupture bleeding is most often caused by pathologic factors in the kidney itself, especially spontaneous rupture of renal neoplastic (renal cell carcinoma, renal vascular smooth muscle tumor, etc.).