Background: Renal stone disease in children is uncommon and causes a clinical management dilemma due to the size of the urinary tract in children and risk of recurrence. The majority of renal stones are due to metabolic disorders or urinary tract infections with a consequently high lifetime risk of recurrence. Objective: To evaluate safety and efficacy of percutaneous nephrolithotomy for the treatment of pediatric renal stones. Patients and Methods: A prospective clinical trial was carried out during the period from February 2018 to October 2019 of thirty pediatric patients ≤ 18 years old with renal stones ˃ 2 cm, shock wave–resistant stones ˂ 2 cm, and failed chemolysis for radiolucent stones. Patients underwent percutaneous nephrolithotomy (PNL) with tract dilation up to 16 fr. A 8/9.8 Fr semirigid ureteroscope (Richard Wolf, Germany), and Ho: YAG Laser lithotripsy were used. Patients were followed up after 3 months of the operation by plain X-ray (Kidney, ureters, bladder [KUB]) (or pelvi abdominal ultrasound [US] for radiolucent stones) & renal isotope to assess safety and efficacy of percutaneous nephrolithotomy. The data were analyzed using the appropriate statistical tests. Results: Our study showed that PNL achieved high stone clearance rate (86.7 %) for management of renal stones in children, with accepted postoperative morbidity. The mean age was 8.48 years (range 2 – 18). Mean diameter of the stone was 21.68 ± 5.55 with a range 10 – 30 mm. Mean operative time was 106.93 ± 13.89 with a range 85 – 135 minutes. Mean hemoglobin loss was 1.1 g/dl. Mean hospital stay was 3.76 ± 0.93 days (range: 3 – 6 days). In our study, renal isotope showed that renal function did not change postoperatively. Conclusion: PNL is a safe and effective procedure for management of renal stones in children.