PurposeTo evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function.MethodsAdults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period.Results240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% (n= 42) had worsening GFR, with the average change in GFR of − 8.64 ml/min/1.73 m2per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% (n= 35) had calcium oxalate stones. Univariate analysis showed older patients (p< 0.001), more symptomatic stone episodes (p< 0.001) and non-calcium-containing stones (p< 0.001) were strongly associated with deteriorating kidney function. Age (p= 0.002) and number of acute stone episodes (p= 0.011) were significant predictive factors when unadjusted to co-morbidities. Age (p= 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was − 2.83/min/1.73 m2per year.ConclusionsRecurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11255-023-03463-x.