Nephrolithiasis in a transplanted kidney –⁠ a current overview of the epidemiology, pathogenesis, diagnosis, treatment, and prevention of recurrence

Czech version

Authors: Pavel Navrátil; Minh Nguyet Tranová
Authors‘ workplace: Urologická klinika LF UK a FN Hradec Králové
Published in: Ces Urol 2026; 30(2): 59-66
Category:
doi: https://doi.org/10.48095/cccu2026011

Overview

Nephrolithiasis in a transplanted kidney is a relatively rare but clinically highly significant complication after kidney transplantation. Even a small stone may lead to urinary tract obstruction, infection, acute deterioration of graft function, and in exceptional cases to graft loss. The reported incidence is heterogeneous and ranges approximately from 0.1 to 6.3%; however, in modern population-based and multicentre cohorts it is most commonly reported at around 1–2%. Clinical presentation is often atypical because the denervated graft frequently does not produce typical renal colic. Diagnostic evaluation therefore relies mainly on regularly performed ultrasonography and, in cases of inconclusive findings or before intervention, on non-contrast computed tomography. Treatment must be individualised according to stone size and location, graft anatomy, the presence of infection or obstruction, and the experience of the treating centre. Smaller stones may be managed with extracorporeal shock wave lithotripsy and ureteroscopic techniques, whereas larger or more complex stone disease usually requires percutaneous nephrolithotomy or its miniaturised variant. Management should not be limited to stone removal alone, but should also include stone analysis, metabolic evaluation, and long-term prevention of recurrence. The aim of this review article is to provide a comprehensive and clinically oriented overview of current knowledge on nephrolithiasis in transplanted kidneys and to translate the available evidence into a practical clinical algorithm.

Keywords:

kidney transplantation – nephrolithiasis – urolithiasis – allograft – ureteroscopy – PCNL – SWL

Sources

1. Skolarikos A, Davis NF, Gambaro G et al. EAU Guidelines on urolithiasis. [online]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urolithiasis-2026.pdf.

2. Kanbay M, Copur S, Bakir CN et al. Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group. Clin Kidney J 2024; 17(2): sfae023. doi: 10.1093/ckj/sfae023.

3. Breda A, Budde K, Figueiredo A et al. EAU Guidelines on renal transplantation. [online]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Renal-Transplantation-2026.pdf

4. Solano A, Gomez Dos Santos V, Breda A. Comprehensive approaches to urolithiasis in renal transplants: a narrative review. J Clin Med 2024; 13(14): 4268. doi: 10.3390/jcm13144268.

5. Ganesan V, Holmes M, Liu S et al. Kidney stone events after kidney transplant in the United States. Clin J Am Soc Nephrol 2023; 18(6): 777–784. doi: 10.2215/CJN.0000000000000176.

6. Sandberg M, Cohen AJ, Wood K et al. Renal transplant nephrolithiasis: presentation, management and follow-up with control comparisons. BJUI Compass 2024; 5(10): 934–941. doi: 10.1002/bco2.436.

7. Cerrato C, Jahrreiss V, Nedbal C et al. Shockwave lithotripsy for de-novo urolithiasis after kidney transplantation: a systematic review of the literature. J Clin Med 2023; 12(13): 4389. doi: 10.3390/jcm12134389.

8. Lim JH, Yang X, Chong TW et al. Ureteroscopy for renal allograft lithiasis: institutional experience and global insights from a systematic review. Transl Androl Urol 2025; 14(12): 3988–4001. doi: 10.21037/tau-2025-574.

9. Cerrato C, Nedbal C, Jahrreiss V et al. URS for de-novo urolithiasis after kidney transplantation: a systematic review of the literature. Minerva Urol Nephrol 2024; 76(3): 286-294. doi: 10.23736/S2724-6051.24.05683-0.

10. Cerrato C, Jahrreiss V, Nedbal C et al. Percutaneous nephrolithotomy for de novo urolithiasis after kidney transplantation: a systematic review of the literature. J Endourol 2024; 38(6): 536-544. doi: 10.1089/end.2023.0398.

11. Boissier R, Rodriguez-Faba O, Zakri RH et al. Evaluation of the effectiveness of interventions on nephrolithiasis in transplanted kidney. Eur Urol Focus 2023; 9(3): 491–499. doi: 10.1016/j.euf.2022.11.019.

12. Challacombe B, Dasgupta P, Tiptaft R et al. Multimodal management of urolithiasis in renal transplantation. BJU Int 2005; 96(3): 385–389. doi: 10.1111/j.1464-410X.2005.05636.x.

13. Stravodimos KG, Adamis S, Tyritzis SI et al. Renal transplant lithiasis: analysis of our series and review of the literature. J Endourol 2012; 26(1): 38–44. doi: 10.1089/end.2011.0049.

14. Lu HF, Shekarriz B, Stoller ML. Donor-gifted allograft urolithiasis: early percutaneous management. Urology 2002; 59(1): 25–27. doi: 10.1016/S0090-4295(01)01490-X.

15. Yin S, Zhou Z, Zhang F et al. Treatment of donors asymptomatic small kidney stones and post-transplant outcomes: a meta-analysis. Urolithiasis 2023; 51(1): 104. doi: 10.1007/s00240-023-01476-w.

16. Sierra A, Etcherverry B, Alvarez-Maestro M et al. Management of deceased and living kidney donor with lithiasis: a multicenter retrospective study on behalf of the renal transplant group of the Spanish urological association. J Nephrol 2024; 37(6): 1621–1630. doi: 10.1007/s40620-024-01960-5.

17. Ganesan V, Liu S, Montez-Rath M et al. Clinical outcomes after a kidney stone event in kidney transplant recipients. Clin J Am Soc Nephrol 2024; 19(8): 1033–1035. doi: 10.2215/CJN.0000000000000451.