Hydronephrosis is common in clinical practice and usually requires management of percutaneous drainage or ureteral stenting in case of anastomotic obstruction. Nephrotic-range proteinuria accompanied with hydronephrosis is rare and may hint at an underlying disorder required to be unveiled and resolved. We report a patient presented with bilateral hydronephrosis and nephrotic-range proteinuria. Timely recognition of the occult autoimmune disorders and successful immunosuppressive treatment avoid unnecessary ureteral stenting.