Background: Obstructive uropathy is life-threatening condition. we evaluated necessity of percutaneous ultrasound guided nephrostomy as an initial drainage in upper urinary tract obstruction focusing on period required for normalization of serum creatinine and factors affecting it, post procedural complications and how we managed. We also recorded the isolated bacteria from urine samples and antibiotic sensitivity patterns. Methods: A prospective clinical study at Nephrology and Urology Minia University Hospital involved insertion of percutaneous nephrostomy in 72 patients presented with upper urinary tract obstruction and serum creatinine level. We recorded any complications appeared and how we managed and focused on factors affected renal recovery. Results: In the current research, the outcome of 72 patients underwent sonar guided PCN insertion have been described. 80.6% of patients recovered to normal renal function tests that is highly significant while 19.4%of patients still had impaired renal function tests. Age and baseline creatinine were the only significant predictors to normal renal function. 10 patients suffered from bleeding; two patients needed blood transfusion. Success rate was 100%. The most isolated bacteria were E-coli. Conclusion: Obstructive Uropathy is a urological emergency that requires rapid diagnosis and prompt treatment for the purpose of decompression and preservation of renal parenchyma. PCN is a safe and effective procedure in management of acute kidney injury due to post renal pathology. it is Suitable for risky or unfit patients for anesthesia as it requires local anesthesia. The lower pre-creatinine level and rapid intervention have great role in normalization of renal function tests.