Do kidney stones cause chronic kidney disease (CKD)?

Do Kidney Stones Cause CKD?

Yes, kidney stones are associated with an increased risk of developing chronic kidney disease (CKD), though the relationship is complex and the evidence suggests this may not be a simple direct causal pathway. 1

The Evidence on Kidney Stones Leading to CKD

The most recent 2025 European Association of Urology guidelines explicitly state there is "emerging evidence linking nephrolithiasis to the risk of chronic kidney disease" and emphasize that stone-related risks arise from obstruction, infection, genetic conditions, metabolic disorders, and urological treatments—all of which may impact renal function 1. The guidelines recommend that all risk assessments should consider CKD, end-stage kidney disease (ESKD), and metabolic bone disorder when evaluating stone patients 1.

Observational Evidence Shows Increased Risk

Multiple observational studies demonstrate that stone formers have elevated CKD risk:

• A 2020 Taiwan nationwide cohort study found stone formers had 1.82 times higher risk of developing CKD compared to matched controls, with 11.2% incidence versus controls 2
• A 2009 Olmsted County study showed stone formers were at increased risk for sustained elevated creatinine and reduced GFR after adjusting for comorbidities 3
• A 2017 meta-analysis pooled seven studies and found a 47% increased adjusted risk (RR 1.47) for CKD among those with kidney stone history 4

The Causal Relationship Is Questioned by Genetic Studies

However, the most recent and highest-quality evidence using Mendelian randomization challenges direct causality:

A 2024 study in JASN using bidirectional Mendelian randomization found that kidney stones are unlikely to be an independent and direct cause of CKD in the general population 5. This genetic analysis revealed:

• No significant genetic correlation between kidney stones and CKD
• Unadjusted analysis showed no association between kidney stones and CKD risk
• Any association with albuminuria disappeared in multivariable models
• Cross-sectional analysis found no independent association between stones and eGFR or albumin-creatinine ratio

The Reverse May Actually Be True

Surprisingly, CKD may actually protect against kidney stone formation 5, 6:

• Genetically predicted lower eGFR and CKD were associated with lower risk of kidney stones (OR 0.78 and 0.89 respectively) 5
• Lower eGFR correlates with lower urinary calcium excretion and reduced calcium oxalate/phosphate supersaturation 5
• A 2026 study confirmed that kidney function decline was associated with reduced KSD risk through shared genetic pathways related to calcium homeostasis 6

Clinical Implications: What This Means for Practice

The Shared Comorbidity Explanation

The observational association between stones and CKD is likely explained by shared risk factors rather than direct causation:

• Hypertension, diabetes, obesity, and metabolic syndrome increase risk for both conditions 2, 4, 3
• When genetic studies control for these confounders, the stone-CKD association disappears 5

When Stones DO Cause CKD

Important caveat: Kidney stones definitively cause CKD in specific high-risk scenarios 1, 7:

• Rare hereditary disorders: Primary hyperoxaluria, cystinuria, Dent disease, adenine phosphoribosyltransferase deficiency 3, 7
• Recurrent obstruction: Multiple episodes causing hydronephrosis
• Infection stones: Struvite stones with chronic pyelonephritis
• Bilateral disease or solitary kidney: Where stone burden directly compromises renal mass

Practical Monitoring Recommendations

Despite the uncertain direct causality, stone formers warrant CKD monitoring because:

1. Screen for shared metabolic risk factors that drive both conditions 1

2. Monitor renal function in high-risk stone formers, particularly those with:

   • Recurrent stones (≥2 episodes)
   • Bilateral disease
   • Family history suggesting genetic disorders
   • Infection stones
   • Young age at presentation (<25 years) 1

3. Obtain baseline and follow-up measurements:

   • Serum creatinine and eGFR
   • Urinalysis for proteinuria
   • Consider 24-hour urine metabolic evaluation in high-risk patients 8, 9

Bottom Line

Kidney stones themselves are not an independent cause of CKD in most patients, but they serve as a marker for individuals with metabolic abnormalities who are at higher risk for both conditions 5. The exception is rare genetic disorders and scenarios with recurrent obstruction or infection, where stones directly damage kidney function 3, 7. Focus on identifying and treating the underlying metabolic drivers (hypertension, diabetes, obesity) rather than viewing the stone as the primary culprit for future CKD risk.