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ABSTRACT   BACKGROUND: Most congenital anomalies of the urinary tract present with hydronephrosis. Some are physiological while others pathological. Ultrasound, micturating cyst urethrography, dynamic renal scintigraphy, intravenous urography, dynamic and static magnetic resonance urography are used for examination. Currently, renal arterial Doppler resistance index is used as complimentary mechanism. This study assesses our experience in resistive index measurement in differentiating obstructive from non-obstructive hydronephrosis in children.  METHODS: A cross-sectional study of forty-two infants and children (<14 years) with hydronephrosis were enrolled using consecutive sampling. Ultrasonography to assess the degree of hydronephrosis and avoiding cystourethrogram were used for the diagnosis of vesicoureteral reflux and posterior urethral valve. Intravenous urogram and surgery were used to confirm causes for obstructive hydronephrosis. Doppler ultrasonography assessed both kidneys to determine mean resistive index for both obstructive and non-obstructive hydronephrosis as well as non-obstructive kidneys. Independent t test was used for analysis at p< 0.005.  RESULTS: The major cause for obstructive hydronephrosis was pelvi-uretheric junction obstruction (47.6%) followed by posterior urethral valve (16.7%). For non-obstructive hydronephrosis, vesicoureteral reflux was the main cause followed by prune belly syndrome. The mean resistive index for non-hydronephrotic kidneys was 0.6654 ±0.053, for non-obstructive hydronephrotic ones was 0.6825 ± 0.06668 and obstructive ones was 0.7791 ± 0.11977. The mean resistive index difference between the obstructive and non-obstructive hydronephrosis was 0.09661 with standard error of difference 0.02443. The difference was statistically significant (P-<0.001). A mean RI ROC curve showed sensitivity, specificity and accuracy of 71.1%, 81.2%, 75.4% respectively (p=0.003).  CONCLUSION: This study has shown that the mean renal arterial resistive index was significantly higher in obstructive hydronephrotic kidneys than non-obstructive hydronephrotic kidneys. This can be a valuable tool for diagnosis and follow-up after intervention.