Endometriosis affects approximately 10% of premenopausal women, with urinary tract involvement in 1% of cases. Ureteric endometriosis is a rare, typically asymptomatic, cause of obstructive renal failure. We present the case of a 30-year-old woman with stage IV endometriosis and advanced human immunodeficiency virus presenting with acute, severe left flank pain and kidney injury. Imaging revealed severe, bilateral hydronephrosis due to extensive endometriosis deposits obstructing the urinary tract. Recurrent ureteric obstruction by infiltrating endometrial disease necessitated eight procedures (bilateral nephroureteric stent placements and nephrostomy insertions). Despite the severity of the disease surgery was successfully avoided. At the time of discharge and subsequent follow-up, the patient was clinically well with stable renal function (Creatinine 1.33-1.61 mg/dL). This case highlights the importance of considering endometriosis in the differential diagnosis of acute kidney injury in women. It demonstrates successful non-surgical management of severe ureteric disease to prevent irreversible renal damage.