Silent Obstructive Nephrolithiasis Resulting in a Non-functional Kidney

Asymptomatic nephrolithiasis can lead to progressive and irreversible kidney damage. We report a 79-year-old woman with incidentally discovered bilateral kidney stones identified on low-dose computed tomography (CT) imaging performed for lung cancer screening. Imaging revealed a 24 mm left renal stone with severe cortical thinning, suggestive of markedly reduced left renal function, and an 8.7 mm right ureteral stone causing hydronephrosis in a functional kidney. The patient denied flank pain, discomfort, hematuria, or other urinary symptoms. Laboratory evaluation demonstrated preserved renal function with a creatinine of 0.9 mg/dL and an estimated glomerular filtration rate (eGFR) of 65 mL/min/1.73 m². The obstructed right kidney was treated with lithotripsy and ureteral stone removal, while the left kidney was managed conservatively. Guideline-based follow-up and preventive measures were initiated to preserve the remaining renal function. This case highlights that silent obstruction may lead to irreversible renal damage, emphasizing the importance of timely detection and management, particularly in patients with a solitary functioning kidney.