Percutaneous nephrostomy is commonly indicated for one of four reasons:
» relief of urinary obstruction
» urinary diversion
» access for therapeutic interventions
» access for diagnostic interventions

The first indication is the most common and occurs when bilateral obstruction has occurred or in the individual with only one functioning kidney. It is especially important when the patient demonstrates hydronephrosis in the setting of obstruction and fevers, leukocytosis or evidence of frank sepsis.

The second indication, diversion of urine, may be necessary when there has been trauma to the urinary system.

The third indication, access for diagnostic inventions, includes biopsy, antegrade pyelograms and the Whitaker test.

Access for therapeutic interventions includes stricture dilatation, stent placement, foreign body removal and stone therapy.