Abstract: Objective To investigate the diagnosis and treatment of urinary tuberculosis complicated with chronic kidney disease and provide guides for the accurate treatment of urinary tuberculosis. Methods To collect the clinical data of three patients suffered urinary tuberculosis complicated with chronic kidney disease hospitalized from Jan.2016 to Dec.2016 in tuberculosis department of the Tenth People’s Hospital ,Shenyang. the history of medicationand treatment was analyzed in three patients who were farmers Results The 3 cases was delayed diagnosis from 5 to 10 years. Case 1 mainly presented with "urinary frequency, urgency, nocturia"; Case 2 had symptoms of" hematuria, urinary incontinence"; Case 3 with "fever, weak". All 3 patients had a long misdiagnosed history as other urinary tract bacteria infections or prostate disease and accepted an unfavorable treatment Cases 1 and 2 had imaging changes of pulmonary tuberculosis, but no symptom. Case 1 showed sterile pyuria, proteinuria, Xpert Mtb / RIF test, DNA amplification qualitative test, Mycobacterium tuberculosis rapid liquid culture (BACTEC MGIT 960) and Mycobacterium tuberculosis antigen MPB64 test in their urine specimen were all positive. Case 2 showed severe hematuria, urine tuberculosis-related test were negative. Case 3 had a acidic urine changes, urine tuberculosis-related examination was negative. The case 1’ showed bilateral multiple renal cavitation on his renal CT, unilateral kidney destruction，contralateral ureterohydronephrosis and extension. In Case 2 ,his CTU showed unilateral kidney damage, contralateral ureterohydronephrosis, contracted bladder presents with diffuse thickening of the bladder wall。 The feature of renal MRI in Case 3 was right autonephrectomy，bilateral multiple renal cavitation ,left renal parenchyma thinning. The three patients were diagnosed by urine Xpert Mtb / RIF positive test in case 1,’ histopathology of a sample obtained through renal surgery in Case 2; MRI imaging in Case 3, respectively. Two patients selected first-line drugs（isoniazid, rifampicin）and second-line fluoroquinolone（Moxisfloxacin）because of the chronic kidney disease stage 5, and hemodialysis alternative therapy., case 1 selected the same regiman but added pyrazinamide due to the normal range of uric acid. Case 2 suffered with urinary TB with chronic kidney disease stage 3, regimen of isoniazid, rifapentine, pyrazinamidewas selected. Followed up from 6 months to 1 year, 3 cases was stable. Conclusion Long-term diagnosis delay of urinary tuberculosis can easily lead to kidney damage,which should be noticed by urology doctors and tuberculosis doctors