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We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was 7.0±2.6 years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median 114±53.6 to 342.1±68.3 ml (p=.0001), 68.5±19.9 to 28.2±6.9 cm H2O (p=.0001), and 3.0±2.1 to 12.8±3.9 (p=.0001), respectively. Renal function remained stable and improved in 22 (76%) patients from median eGFR 135±81.98 to 142.82±94.4 ml/min/1.73 m2 (p=.160). Significant deterioration was found in 7 (24%) patients from median eGFR 68.25±42 to 36.57±35.33 (p=.001). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87, p=0.0155) and noncompliance (OR 30.78, p=0.0156) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency.