Objective To investigate the indication to retain the involved kidney in the surgical treatment of upper urinary tract stone accompanied by renal insufficiency in children. Methods 118 cases of upper urinary tract stone accompanied by renal insufficiency in children were retrospectively studied. Results 118 children with kidney or upper segment ureteral stone accompanied by renal insufficiency underwent lithotomy and nephrostomy,115 of them have been cured of the disease ( 97.5 %).3(2.5%) died.No upper urinary tract stenosis has been observed. Conclusions Early diagnosis and prompt relief of the obstruction are the key points to protect and retain the involved kidney.Clinical history and physical sign,the thickness of the renal cortex and the renal function,complicated by infection or not are the cardinal factors to be considered in order to achieve a success in retaining the involved kidney.