Researchers have determined in a new study that percutaneous nephrolithotomy (PCNL), a common method for the removal of large kidney stones, maintains renal function in those with moderate to severe chronic kidney disease (CKD). The study was published in theWorld Journal of Urologyby Vinay D. and colleagues. The study evaluated patients with a baseline preoperative estimated glomerular filtration rate (eGFR) of less than 45, categorized as CKD stage ≥3b. A total of 29 patients were included in this cohort, with 83% classified specifically as CKD 3b. Preoperative and postoperative eGFR levels were compared to evaluate alterations in renal function. Outcomes examined were progression to dialysis, ∆eGFR (delta change in eGFR), and CKD stage transitions. For comparison purposes, control groups included patients with preoperative stages 3a CKD, 2 CKD, and ≤1 CKD, matched with the CKD ≥3b cohort. Key Findings At baseline, the median preoperative eGFR of the CKD ≥3b group was 38 (IQR 31–42). Median renal function follow-up was 8 months (IQR 2–13). Dialysis-free survival at one year was 87%, which meant that most of the patients managed to stay away from end-stage renal disease. No difference was noted between preoperative and postoperative eGFR (p=0.97) and median ∆eGFR was 0 (IQR −6 to 6). Out of CKD stage changes, 62% of patients stayed the same, 21% had improvement, and only 17% had worsening. The ∆eGFR and CKD stage results in the CKD ≥3b group were similar to patients with CKD stages 3a and 2, and superior to those with CKD stage 1 (p=0.02). In moderate to severe CKD patients, PCNL was concordant with stable or improved renal function in the majority, with a low incidence of deterioration to dialysis. Such findings attest to the efficacy and safety of PCNL in the treatment of large kidney stones in high-risk CKD patients. Specialists can handle such situations with increased assurance, understanding that PCNL does not significantly impair kidney function and frequently is conducive to stability or improvement over the intermediate term. Durbhakula, V., Savin, Z., Frangopoulos, E. et al. Should percutaneous nephrolithotomy be performed in patients with severe chronic kidney disease? A closer look at renal function outcomes. World J Urol 43, 533 (2025).https://doi.org/10.1007/s00345-025-05906-9