Background: Hydronephrosis is a major problem and colour doppler ultrasound is very useful to assess the hemodynamics of a diseased kidney, it is a therefore our research comprises sonographic analysis of segmental artery resistive index with the severity of hydronephrosis. Materials and Methods: This was a cross sectional analytical study carried out in Gilani Ultrasound center‑Afro‑Asian Institute, Lahore, Pakistan. Sixty patients of all ages were enrolled in this study with convenient sampling technique. A total of 60 individuals of all ages, both genders with calculus, masses, pregnant females, benign prostatic hyperplasia, (all the patients having hydronephrosis) were included in the study and individuals with Renal transplanted patients, nephrectomy, non-cooperative patients were excluded. The duration of the study was from December 2018 to October 2019. Toshiba (Xario 200) with convex transducer frequency range 2–5 MHz was used for this study. Age, gender, grade of hydronephrosis, pulsatility index and resistive index of segmental artery were the variables used in this study. Transabdominal scanning technique was used, Data were collected through data collection sheets and was tabulated and analyzed using Statistical Package for the Social Sciences (SPSS) version 24 (SPSS 24, IBM, Armonk, NY, United States of America), Microsoft Excel. Results: According to the results male patients with hydronephrosis (51%) were noted more than female hydronephrotic patients (48%). Mostly seen hydronephrosis grade in our study was mild (60%) while moderate hydronephrosis was (38.3) and severe was (1.7%). In our studies patients with left kidney hydronephrosis (56.7%) were more than that of right kidney hydronephrotic patients (43.3%). CONCLUSION(S): It is concluded that Doppler analysis is very helpful in the diagnosis of severity of hydronephrosis and to give detailed information about the pathophysiology of the hemodynamics of diseased kidney.