This is a study of 1607 patients with a urolithiasis-related obstructive uropathy between January 2005 and December 2015. Clinical outcomes were evaluated with respect to obstruction duration, acute kidney injury (AKI), and acute pyelonephritis (APN) accompanied by obstructive uropathy. The primary objective of this study was to evaluate whether the duration of urinary tract obstruction affects the renal outcome. The secondary objective was to evaluate whether the AKI, APN or both events affect the renal outcome. Renal outcomes were evaluated with an eGFR decrease ≥ 30% and/or end-stage renal disease (ESRD), and an eGFR decrease ≥ 50% and/or ESRD. Obstruction duration is an independent risk factor for poor renal outcome with concomitant APN and AKI in urolithiasis related obstructive uropathy. Early obstruction release may contribute to the improvement of prognosis by reducing the incidence of infection or acute renal failure.