Can You Survive With Only One Kidney?

If you were born with one kidney, or donated one, you might want to read this

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James Curley, collections specialist for the National Museum of Health and Medicine's (NMHM) Historical Collections, shows participants at NMHM's August Organ of the Month Club program a papier-mâché model of a kidney. Military Health; Creative Commons Attribution 4.0 International Public License

A person can end up with one kidney because of various reasons.  Here are some common situations:

  • Acquired absence of the kidney because of surgical removal.  This is a common situation that patients with cancer of the kidney might face.
  • Voluntary donation of a kidney (to be transplanted into a patient with kidney failure).
  • Being born with one kidney.  These are patients where one of the kidney might not develop normally before birth.  Such patients will then be born with one kidney and may not even have knowledge of the fact.  The situation is usually discovered incidentally when imaging is done for other reasons.

    So, can one survive on one kidney?

    This is not a simple answer.  The most educated answer would be to say, "it depends on the cause". It also clearly depends on whether the patient has other typical reasons for kidney disease (diabetes, high blood pressure, etc).  Hence a person with none of these disease conditions but born with one kidney, is not the same as an obese hypertensive and diabetic patient who had a kidney removed because of kidney cancer, who in turn might not be the same as the otherwise-healthy middle aged person who donated one of their kidneys to their loved ones (I have talked about this in another article).  

    Is regular monitoring necessary?

    At the very minimum, most nephrologists would recommend regular monitoring of the kidneys' function.  This is done by looking for signs of kidney damage in the blood and urine.

    One test that is often missed by a lot of non-nephrology physicians when it comes to the evaluating a patient with a solitary kidney is a test for protein in the urine.

     While the person with one kidney might have perfectly normal kidney function numbers in the blood, they might still be spilling protein into the urine which is a sign of damage to the kidneys filter, or the glomerulus. In medical parlance, this is called adaptive hyperfiltration. Patients with adaptive hyperfiltration- related protein in the urine might have to be put on certain medications called ace inhibitors or angiotensin blockers (these are common blood pressure medications).

    Some nephrologists will put a patient on these medications for protein in the urine even if the blood pressure is normal.

    Speaking about blood pressure; monitoring patients for high blood pressure is an integral part of keeping an eye on the kidney function in a person with a solitary kidney.  Remember, the kidneys have a huge role in regulating your blood pressure. They're often considered the "thermostat" for the body's blood pressure regulation. Hence, an indirect sign of something being wrong with the kidney could just be elevation in blood pressure. Hence it is prudent to track blood pressure readings regularly.

    Is any specific treatment required in the absence of objective evidence of kidney damage?

    Usually, no.  However, a common sense approach should still be taken.  Medications or agents that are toxic to the kidney should still be avoided.  And I do not see why a patient would have anything to lose by eating an otherwise healthy diet which is typically recommended for most patients with early chronic kidney disease.

     This could just be a DASH diet, a diet that is essentially low in saturated fat and sodium, and high in fiber and protein.

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