We present a retrospective analysis of 26 clinical cases of patients with terminal stage of chronic kidney insufficiency (TCKI) and active pyelonephritis with the background of urological disease, which received nephrectomy. In the beginning we used the aggressive tactics of bilateral nephrectomy, even when the pathological process was primarily one-sided. This approach could eliminate the evident and potential infections sites in kidney, which were already nonfunctional. In patients with good somatic condition this approach was safe, but in septic patients with long history of hemodialysis this approach tended to show almost 100% lethality. We have review our surgical tactics. In septic patients only two-sided purulent pyelonephritis could be an indication for bilateral nephrectomy, at that the operation was multi-staged. However, this way did not lead to better results. One sided purulent process in kidney was an indication for one-sided nephrectomy without lethal outcomes. It was shown, that statistically significant negative predictors were: sepsis, therapy with wide-spectrum antibiotics before the operation, programmed hemodialysis. This aspect requires the prophylactic nephrectomy in patients of the risk group before the development of sepsis. Risk group is characterized through the following criteria: TCKI as a consequence of urologic disease, polycystosis of the kidneys, recurrent chronical pyelonephritis.