Objectives:The aim of this study was to determine whether unenhanced computed tomography (CT) imaging can estimate differential renal function (DRF) in patients with chronic unilateral obstructive upper urinary tract stones. Materials and Methods:This was a single-center retrospective study of 76 patients. All the patients underwent unenhanced CT and nuclear renography (RG) at an interval of 4 to 6 weeks due to chronic unilateral obstructive urinary stones. Renal CT measurements (RCMs), including residual parenchymal volume (RPV) and volumetric CT texture analysis parameters, were obtained through a semiautomatic method. Percent RCMs were calculated and compared with renal function determined by RG. Results:The strongest Pearson coefficient between percent RCM and DRF was reflected by RPV (r= 0.957,P< 0.001). Combinations of RPV and other parameters did not significantly improve the correlation compared with RPV alone (r= 0.957 vs.r= 0.957, 0.957, 0.887, 0.815, and 0.956 for combination with Hounsfield unit, parenchymal voxel, skewness, kurtosis, and entropy, respectively; allP< 0.001). Percent RPV was subsequently introduced into linear regression, and the equation y = -2.66 + 1.07*x (P< 0.001) was derived to calculate predicted DRF. No statistically difference was found between predicted DRF using the equation and observed DRF according to RG (P= 0.959). Conclusion:Unenhanced CT imaging can estimate DRF in patients with chronic unilateral obstructive upper urinary tract stones, and RG might not be necessary as a conventional method in clinical.