Living with One Kidney — Adapting, Thriving, and Protecting Long-Term Renal Health
- Andrew Kowalski
- Apr 30
- 4 min read
Andrew Kowalski, MD, FASN
Introduction
Many individuals are born with or acquire a solitary kidney due to congenital absence (renal agenesis), surgical removal (nephrectomy), or organ donation.
While living with one kidney is often compatible with a normal, healthy life, it presents a unique physiological and metabolic scenario that demands attention to long-term renal health. This blog explores the implications of living with a single kidney, outlines potential risks, discusses lifestyle modifications to safeguard kidney function, and reviews appropriate pharmacologic supports.
Physiological Adaptation to a Single Kidney
After the loss or absence of one kidney, the remaining kidney undergoes compensatory hypertrophy, increasing in size and function to maintain glomerular filtration rate (The amount of blood filtered per minute; GFR). Initially, this hyperfiltration (increased work within the kidny to remove toxins) is beneficial, preserving balance within the body. However, over time, sustained hyperfiltration may lead to glomerular sclerosis, proteinuria, and a gradual decline in kidney function—mimicking the pathophysiology of early CKD.
Key concerns in long-term adaptation:
Increased intraglomerular pressure
Higher risk of microalbuminuria and proteinuria (increases the risk of progression)
Predisposition to hypertension (hormonal changes within the kidney may lead to a direct and indirect increase in blood pressure)
Elevated risk with comorbidities like diabetes or obesity (due to increased inflammation)
Risk of CKD Progression in Solitary Kidney Patients
While many people with one kidney maintain normal renal function for life, several factors influence the risk of progression to CKD:
Risk Factor | Impact |
Hypertension | Increases glomerular pressure and accelerates damage |
Proteinuria | Marker and mediator of renal damage |
Obesity and Metabolic Syndrome | Promotes hyperfiltration, inflammation, and insulin resistance |
Diabetes Mellitus | Raises risk of microvascular damage to glomeruli |
History of AKI | Even one episode can reduce nephron reserve in the solitary kidney |
High Protein Intake | May contribute to glomerular hyperfiltration in predisposed individuals |
Lifestyle Modifications for Renal Preservation
Nutritional Adjustments
Moderate protein intake: Aim for 0.8 g/kg/day of high-quality protein unless otherwise indicated (e.g., athletes, undernourished).
Salt restriction: Target <2,300 mg/day sodium to control blood pressure and reduce hyperfiltration.
Plant-forward diet: Emphasize fruits, vegetables, whole grains, legumes—supporting endothelial health and reducing acidosis. This also implies a reduction in highly processed "comfort foods" like baked goods, cookies, candies and so forth.
Hydration: Maintain adequate fluid intake, avoiding both dehydration and fluid overload.
Limit nephrotoxins: Avoid NSAIDs, excessive protein supplements, contrast dyes, and unverified herbal remedies.
Physical Activity
Engage in moderate aerobic and resistance training: supports cardiovascular health, insulin sensitivity, and weight control. If possible choose resistance training over cardio. The benefits of increased and/or stable muscle mass exponentially outweighs aerobic exercise, which can decrease muscle mass if not careful.
Avoid high-contact sports (e.g., football, martial arts) without protective gear to reduce trauma risk.
Weight Management
Obesity promotes glomerular hyperfiltration and accelerates sclerosis. Maintain a healthy BMI (18.5–24.9).
Blood Pressure Control
Target <130/80 mmHg. Home monitoring is encouraged.
Lifestyle changes should be paired with pharmacological treatment if necessary.
Supporting Medications for Renal Protection
When used appropriately, medications can significantly reduce the risk of CKD progression in solitary kidney patients. Many of the medications used today work together to protect the kidney.
Medication Class | Role in Renal Health |
ACE inhibitors / ARBs | Reduce intraglomerular pressure, control blood pressure, lower proteinuria |
SGLT2 inhibitors (e.g., dapagliflozin) | Shown to protect kidney function even in non-diabetic patients (under study) |
Statins | Manage dyslipidemia and reduce vascular risk, indirectly benefiting renal circulation |
Diuretics (thiazide or loop) | Useful in volume control if hypertension or edema present |
Vitamin D analogs | Considered if PTH levels elevate due to reduced nephron mass |
Sodium bicarbonate | For those with metabolic acidosis; slows CKD progression |
Note: Close monitoring of eGFR and serum potassium is essential when using ACEi/ARB and SGLT2i.
Monitoring and Follow-up
Regular surveillance ensures early detection of complications and timely intervention:
Monitoring Parameter | Recommended Frequency |
Serum creatinine and eGFR | Every 6–12 months (more often if comorbidities present) |
Urine albumin-to-creatinine ratio (ACR) | every 6 months or as indicated by your provider |
Blood pressure | Every clinical visit or home monitoring |
Electrolytes (K+, Na+, bicarbonate) | Annually or with medication adjustments |
Lipid profile | Annually |
Psychological and Social Considerations
Living with one kidney may bring emotional concerns—especially for organ donors, cancer survivors, or those who experienced traumatic loss of an organ. It’s important to:
Foster positive reinforcement and health literacy
Address anxiety with education and reassurance
Encourage peer support or counseling where necessary
Image from "One Kidney, Two Lives" ANNA DAUGHERTY IN TXEX ON DECEMBER 7, 2015
Conclusion
Living with one kidney, while often asymptomatic, requires a proactive and informed approach to health management. With strategic lifestyle changes, appropriate medication, and regular monitoring, individuals with a solitary kidney can live full, healthy lives while minimizing their risk of CKD progression. Early intervention, empowerment through knowledge, and holistic care form the cornerstone of long-term renal wellness in this unique population.
Click above for a downloadable PDF to review or to use to speak with your healthcare Provider.