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Obstructive uropathy is an important clinical entity that both urologists and nephrologist deal with. The aim of this study is to provide the available data up to date concerning the etiopathophysiology and the possible treatment options for this emergency situation. A literature search was performed for articles in English, published in journal indexed in Medline from 1970 to 2013, using as keywords:“obstructive uropathy”,“acute renal failure”,“hydronephrosis”,“unilateral renal obstruction” and “bilateral renal obstruction”. Patients suffering from obstructive uropathy may be unaware of their problems, especially if the onset is gradual. Obstructive uropathy is responsible for a wide range of metabolic and electrolytic abnormalities that may lead to renal failure especially if the obstruction is bilateral and/or if there was a preexisting degree of renal failure. The timeframe from the occlusion of the collecting system to the development of renal impairment is shorter than we initially thought. Hopefully, nowadays there are plenty of diagnostic workouts to help urologists and nephrologists to diagnose and plan the treatment of obstructive uropathy. Obstructive uropathy needs high clinical suspicion and urgent diagnostic and therapeutic workout.