Can You Live With One Kidney?

Your kidneys have the very important job of filtering your blood and helping your body rid itself of waste. They usually come in pairs of two, but people sometimes end up with only one that functions properly. Why? Well, it depends. You can end up living with one kidney if:

• You donated a kidney.
• You had one removed because of chronic kidney disease (CKD), injury or cancer.
• You were born with one kidney.
• You were born with two, but only one was functional at birth.
• You were born with two, but one stopped functioning later in life because of damage resulting from conditions like a ureteral obstruction or renal artery stenosis (lack of blood flow).

Can you survive with one kidney? If so, what will life be like once you’ve lost such an important organ?

Nephrologist and kidney medicine specialist James Simon, MD, answers these questions and provides advice for how to protect the kidney you have left.

Can you live with one kidney?

If you have one kidney, you can live a long, healthy life depending on a variety of factors like age, any underlying conditions and the overall health of your kidneys at the time one is lost.

“The healthier and younger the kidney is, the more it can grow and take up a lot of the slack,” says Dr. Simon. “Typically, someone’s kidney function may drop a little bit, but still stay within the normal range, and those people can live fine for the rest of their lives with just one kidney.”

Your kidneys tend to lose some of their function as you get older. So, if you lose a kidney in your 60s, your remaining kidney will have to work harder with less.

“If you’re 65 and you lose a kidney, the other kidney is not as healthy as it used to be. Maybe the function is fine but inside, the blood vessels are 65 years old and your filtering units don’t have as much ability to take up the slack,” explains Dr. Simon. “What I expect to see in a person like that is that their kidney function gets cut in half. It may recover some of that function, but not as much as when you were 30.”

What are the restrictions for people with one kidney?

If your remaining kidney is working fine, there’s no reason to have any restrictions on what you do, the foods you eat or how you live your life. In some cases, you may want to avoid high-impact sports (like football) to reduce the likelihood of a kidney injury, but that tends to be a personal decision.

What health problems can develop in people with one kidney?

If you have one kidney, even if it functions well, you may eventually develop high blood pressure or an increase in protein in your urine (proteinuria), which can be a sign of kidney damage. If you’ve lost a kidney, including as a living donor, you should continue to have annual follow-ups with your primary care provider to make sure your remaining kidney is healthy and strong. By monitoring the health of your kidney, the goal is to get ahead of any potential complications that could arise.

Depending on how old you were when you lost a kidney, you may develop chronic kidney disease in your remaining kidney. For this reason, it’s important to understand how well your kidney is functioning. Your healthcare team will monitor your estimated glomerular filtration rate (eGFR) as a marker of how well your kidney is cleaning your blood.

“People with CKD, regardless of whether they have one kidney or two, are at increased risk of developing high blood pressure, cardiovascular disease and other problems,” notes Dr. Simon. “The main driver of this risk is what your eGFR is now that you have one kidney, not the fact that you have one kidney in and of itself.”

What foods should you avoid after removal of one kidney?

If you’ve lost a kidney and your remaining kidney is healthy and functioning, you don’t have to make any changes to the foods you eat. But it’s always recommended to eat a heart-healthy, low-sodium diet. That’s good in general for your kidney and the rest of your body.

But if your kidney starts losing significant function, you may need to adjust your meal plans — similar to someone who has two kidneys that aren’t fully functioning.

Lower eGFR levels can be associated with a build-up of key electrolytes like potassium. In such cases, the renal diet can be helpful, but you should talk with your nephrologist before making such big changes.

“Always talk to your kidney doctor or a nutrition specialist before starting a renal diet, as it requires avoiding some otherwise healthy foods that are high in key electrolytes like potassium,” cautions Dr. Simon. “We only restrict these in the diet when the kidney(s) cannot keep up with cleaning them out of the blood.”

Protecting your remaining kidney

“The underlying health of your remaining kidney will determine how well it holds out,” states Dr. Simon. “Since you only have one kidney, if something happens to it and that kidney fails, all your cards are on the table.”

Even something as small as a kidney stone can become an emergency if your kidney’s function becomes disrupted for a period of time.

Anything that’s good for your overall health and wellness will be good for your kidney health, too. That means you’ll want to:

• Exercise regularly.
• Eat balanced meals with healthy fats, protein, fruits and vegetables.
• Stay hydrated by drinking plenty of water.
• Stop smoking.
• Limit your use of alcohol.
• Use nonsteroidal anti-inflammatory medications (NSAIDs) sparingly.

“The only difference between having two kidneys and one kidney is now, you have half of the filtering units available to clean out your blood, so they’re working twice as hard as they would have been,” explains Dr. Simon. “So, you want to do everything you can to protect your remaining kidney.”