- Design
- Systematic review and meta-analysis
- Population
- 7 studies, 742 patients with CKD or reduced baseline kidney function
- Primary outcome
- Change in eGFR after ureteroscopy or retrograde intrarenal surgery
- Effect
- Mean difference +2.8 mL/min/1.73 m² (95% CI −2.8 to +8.4), I² 89.6%
Nephrologists are often asked whether ureteroscopy or retrograde intrarenal surgery will harm residual function in a patient with CKD, given concerns about intrarenal pressure and repeated procedures. This meta-analysis from European Association of Urology endourology researchers pooled seven studies (742 patients with reduced baseline function).
The pooled change in eGFR was +2.8 mL/min/1.73 m² (95% CI −2.8 to +8.4), with very high heterogeneity, so no significant change overall. One study of ureteric stones reported a larger rise, consistent with relief of obstruction. No study attributed progression to dialysis to the procedure. Certainty was very low.
The data are weak, but they do not support withholding stone treatment from patients with CKD for fear of losing function. Untreated obstruction is itself a threat to the kidney.
- Do not withhold indicated ureteroscopy from patients with CKD solely out of concern for kidney function.
- Check eGFR before and after the procedure in patients with reduced function.
- Treat obstructing stones promptly; relief of obstruction may improve eGFR.
- Review nephrotoxic drugs and contrast exposure around the procedure.
Why it matters
It addresses a common hesitation when a patient with CKD needs stone surgery.
Don't overread it
Seven heterogeneous, mostly observational studies with very low certainty.
The statistics, in plain English
The interval from −2.8 to +8.4 includes no change, and I² of 90% means studies differed greatly. The evidence is reassuring in direction but very uncertain in size.
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