Salinity is an important ecological factor affecting the osmolality of aquatic animals. Solenaia oleivora is an endemic and economically important freshwater shellfish in China. However, its osmotic response and osmoregulatory mechanisms under high salinity stress are still unclear. In this study, S. oleivora was exposed to saline water (salinity: 2.2‰) for 3 h, 6 h, 12 h, 24 h, and 48 h, and then the changes in osmolality, ion concentrations, free amino acid (FAA) content, Na+/K+-ATPase (NKA) activity, and gill histology were analyzed. The hemolymph osmolality increased from 3 h after salinity stress and stabilized between 24–48 h. Na+ in the hemolymph increased from 24 h after salinity stress, and Cl− increased from 3 h. The content of total FAAs in the hemolymph increased after salinity stress. The content of alanine, glycine, glutamine, proline, and other FAAs increased after salinity stress. NKA activity in the gill, hepatopancreases, adductor muscle, and axe foot decreased during 3–48 h of salinity stress. The gill filament space increased and the number of gill cilia decreased after salinity stress. Principal component analysis (PCA) showed that the first two principal components (PC1 and PC2) cumulatively explained 77.6% of the total variation. The NKA activity was positively associated with PC1, while the ion concentration and most FAAs were negatively associated with PC1. Thus, these results indicated that S. oleivora is an osmoconformer, and inorganic ions, FAA, NKA, and gill structure changes play an important role in its osmoregulation.