Design: Systematic review and meta-analysis of observational studies
Population: 7 studies, 742 patients with CKD undergoing ureteroscopy or RIRS
Primary outcome: Change in eGFR
Effect: Mean difference +2.8 mL/min/1.73 m² (−2.8 to +8.4); I² 89.6%

A meta-analysis from the EAU endourology group in Urolithiasis (28 September) pooled seven studies, 742 patients with CKD, who had ureteroscopy or retrograde intrarenal surgery, with follow-up from one month to over two years.

The pooled change in eGFR was +2.8 mL/min/1.73 m² (95% CI −2.8 to +8.4), no significant change, with very high heterogeneity (I² about 90%). One study of ureteric stones found a larger rise, plausibly from relief of obstruction. No study reported progression to dialysis attributed to the procedure. Certainty was very low.

For nephrologists advising on stone treatment in CKD, this is modest reassurance that endoscopic stone surgery does not appear to worsen kidney function overall, and may help when a stone is obstructing. The evidence is thin, so measure creatinine before and after.

Ureteroscopy was not associated with an overall fall in eGFR in patients with CKD.
Relief of obstruction may improve kidney function in selected patients.
Check creatinine before and after stone surgery in patients with CKD.
Evidence is very low certainty; individual risk still needs judgement.

Why it matters

Fear of worsening kidney function can delay stone treatment that may itself protect the kidney.

The statistics, in plain English

The confidence interval from −2.8 to +8.4 includes no change. An I² near 90% means the studies disagreed a great deal, so the pooled figure is a rough summary rather than a precise estimate.