Spontaneous renal hemorrhage is a rare and complicated clinical condition. We report a case of spontaneous renal hemorrhage associated with idiopathic thrombocytopenic purpura (ITP). To our knowledge, this is a second case associated with ITP in the literature. The main treatment of our case included absolute bed rest, platelet transfusion, steroid therapy and prevention of infection. The platelet count increased gradually and returned to the safe level greater than 50,000/microliter from the 10th day. The patient was discharged after 2 weeks due to stable condition and received further follow-up in the outpatient department. We suggest that conservative treatment for spontaneous renal hemorrhage caused by blood dyscrasias like ITP is appropriate because immediate surgical intervention may pose a higher risk due to the tendency for severe bleeding. However, long term follow-up by serial CT should be performed to rule out the possibility of concomitant diseases especially small renal cell carcinoma, which is the most common cause of spontaneous renal hemorrhage.