Objective: To investigate the diagnosis and treatment of hemodialysis patients with spontaneous perirenal hemorrhage (SPH). Methods: The clinical analysis of three cases of SPH with hemodialysis were reported and combined with literature review. Results: Of the 3 patients, 2 were treated with acute conservative treatment. The right renal artery embolization was performed in the emergency department, and the kidney was removed in 1 case. The results were basically satisfactory. Conclusion: The clinical symptoms of the SPH patient with hemodialysis depends on the degree of bleeding and duration, most associated with ACKD, mainly for upper abdominal pain. CT is the preferred method of diagnosis of SPH. The treatment should be according to different causes and bleeding and determined, try to take a conservative treatment.