While the effects of percutaneous nephrolithotomy (PCNL) on patients with normal functioning kidneys have been widely studied, the outcomes of PCNL in populations with renal insufficiency remains under reported. We aimed to examine the literature and evaluate the efficacy and safety of PCNL in this non-indexed patient group. A systematic search was performed in accordance with Cochrane guidelines. This served to identify original studies investigating PCNL carried out in the adult population with chronic kidney disease published over the past 20 years (since 1997).