Changes in renal function in patients with chronic kidney disease after ureteroscopy: a systematic review and meta-analysis from EAU endourology.

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 m² (95% CI -2.8 to +8.4; p = 0.27), indicating no significant overall change in renal function, with substantial heterogeneity (I² = 89.6%). A greater increase in eGFR was observed in the ureteral stone subgroup (MD +12.26 mL/min/1.73 m²; 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.