While the sustainment of percutaneous nephrostomy with regular change in chronic un-operable cases is widely performed for relief of urinary obstructions, performance of the blind procedure without fluoroscopic monitoring could result in clinical disaster. We report on a case of direct renal vein injury by mis-guidance of a nephrostomy catheter, which was successfully managed conservatively by serial venography monitoring combined with intensive conservative treatment. To the best of our knowledge, this is the first report on management of a renal vein injury during the percutaneous nephrostomy.