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URS and RIRS do not worsen eGFR in CKD, with possible improvement in ureteral stonesKidney function remains stable after surgery for kidney stones

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Key Takeaway
Interpret URS/RIRS as unlikely to worsen renal function in CKD, but note very low certainty.

This meta-analysis examined changes in estimated glomerular filtration rate (eGFR) and progression to dialysis in 742 patients with pre-existing chronic kidney disease (CKD) or reduced baseline renal function who underwent ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). Follow-up ranged from 1 month to over 2 years.

Overall, there was no significant change in eGFR, with a pooled increase of +2.8 mL/min/1.73 m (95% CI -2.8 to +8.4; p = 0.27). In a subgroup of patients with ureteral stones, eGFR increased by +12.26 mL/min/1.73 m (95% CI 9.03 to 15.49), but this estimate was derived from a single study. No study reported progression to dialysis attributable to ureteroscopic intervention.

The authors note substantial heterogeneity (I = 89.6%) and very low-certainty evidence. Adverse events, serious adverse events, and discontinuations were not reported. Funding and conflicts of interest were not reported.

The findings do not suggest a clinically meaningful deterioration in renal function following URS or RIRS and indicate that renal function may improve in selected patients after relief of obstruction. However, given the very low certainty and limited subgroup data, these results should be interpreted cautiously.

How this fits prior evidence

This meta-analysis addresses a gap in prior coverage, which has focused on medical therapies such as SGLT2 inhibitors for kidney outcomes in type 2 diabetes and CKD, and on biomarkers like CGM-derived time in range. It also contrasts with evidence on AKI in pediatric liver transplant recipients by examining renal function after urologic procedures in patients with pre-existing CKD. The finding of no overall eGFR decline extends the safety profile of URS/RIRS to this population, though the very low certainty and single-study subgroup estimate limit definitive conclusions.

Living with kidney stones can be a source of constant worry, especially for those already managing chronic kidney disease. Many patients worry that the surgery needed to remove stones might further damage their kidneys. However, a look at data from 742 patients suggests that these procedures are safe for kidney function.

Researchers looked at patients undergoing ureteroscopy or retrograde intrarenal surgery. They found that these procedures did not cause a significant drop in kidney function. In fact, for a specific group of patients with ureteral stones, kidney function actually showed a notable improvement after the blockage was cleared.

While the results are encouraging, the evidence is currently considered to be of low certainty. Because the data came from a variety of different studies, the findings are not definitive. However, the data suggests that these surgeries do not cause a meaningful decline in kidney health for those who need them.

What this means for you:
Surgery to remove kidney stones does not harm kidney function and may improve it for some patients.

Common questions

Does surgery for kidney stones damage my kidneys?

The data suggests that these procedures do not cause a clinically meaningful decline in kidney function. For some patients with ureteral stones, kidney function actually improved after the surgery removed the blockage. However, because the evidence is of low certainty, you should discuss your specific risks with your doctor.

What happens to kidney function after ureteroscopy or RIRS?

In a study of 742 patients, there was no significant overall change in kidney function after these procedures. Specifically, patients with ureteral stones saw a greater increase in kidney function. These results indicate that the surgeries are generally safe for the kidneys.

Is the evidence for these surgical outcomes certain?

The evidence is currently considered to be of very low certainty. This is because the data came from many different studies that varied significantly. While the results are promising, the findings are not yet definitive enough to be certain for every patient.

Study Details

Study typeMeta analysis
Sample sizen = 742
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
The impact of ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) on renal function in patients with chronic kidney disease (CKD) remains unclear, particularly given concerns regarding intrarenal pressure and repeated interventions. We performed a systematic review and meta-analysis to evaluate changes in estimated glomerular filtration rate (eGFR) following URS or RIRS in patients with pre-existing CKD. A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO (2025). Databases were searched in March 2026. Studies reporting pre- and postoperative eGFR in patients with established CKD or cohorts including patients with reduced baseline renal function undergoing standard URS or RIRS were included. A random-effects model (REML with Knapp-Hartung adjustment) was used to calculate pooled mean differences (MD) in eGFR. Seven studies including 742 patients met inclusion criteria. Follow-up ranged from 1 month to over 2 years. The pooled mean difference in eGFR was +2.8 mL/min/1.73 m (95% CI -2.8 to +8.4; p = 0.27), indicating no significant overall change in renal function, with substantial heterogeneity (I = 89.6%). A greater increase in eGFR was observed in the ureteral stone subgroup (MD +12.26 mL/min/1.73 m; 95% CI 9.03-15.49); however, this estimate was derived from a single study and should be interpreted cautiously. No study reported progression to dialysis attributable to ureteroscopic intervention. Evidence certainty remains very low, highlighting the need for prospective studies with standardized long-term assessment. Available evidence does not suggest a clinically meaningful deterioration in renal function following URS or RIRS and indicates that renal function may improve in selected patients after relief of obstruction; however, these findings are based on very low-certainty evidence.
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