December 21, 2020
Living Well with One Kidney
Though modern advances in medicine have made it possible, life with a single kidney takes care and consideration.
From donation to removal as the result of malignancy or disease, there are various reasons an individual may need to consider life with a single kidney. Unlike a liver or heart, for example, the human body was designed with two kidneys – which perform the same function. As modern medicine and our incredible biological design would have it, it is possible to live a healthy life while in possession of a single kidney. The “how” of doing it comes down to understanding and total body TLC.
When physicians and patients discuss the possible removal of a kidney, various factors come into play. If a patient has a mass in their kidney that is suspicious for cancer, but cancer has not spread or remains in the kidney alone, the most effective treatment is typically surgery. Surgery can entail a partial or total removal of the kidney, depending on several factors. Some significant indications might point a care team and their patient to removing the entire kidney, rather than partial removal of only the part that contains the tumor. These include a tumor that itself is large or has replaced a large portion of the kidney, a tumor that is centrally located to where all of the kidney’s blood vessels converge, or cancer that has grown outside the kidney and invaded the blood vessels, or a tumor thrombus that is growing inside the renal vein.
Though these indications for removal of a kidney may sound disconcerting, in general, the body can function very well with one kidney and without any noticeable complications in an otherwise healthy individual. When one kidney is removed, the other grows larger to accommodate for the demand on the remaining kidney to filter and clean the blood. However, in patients with baseline kidney failure or kidney disease, diabetes, hypertension, cardiovascular disease, removal of one kidney may cause the progression of kidney failure in the remaining kidney. This progression may not be severe enough to require dialysis. However, it may be severe enough to cause complications such as sodium or potassium imbalances, increased acid build-up in the body, cognitive decline, and fluid retention.
Once a patient makes the ultimate decision to undergo removal of a kidney, recovery from the surgery itself may take 2 - 6 weeks. The timeframe depends on whether the patient underwent robotic, laparoscopic, or open nephrectomy (the clinical term for kidney removal surgery). After the initial recovery period, most healthy patients will not see a change in how they feel with one kidney versus two. However, it is recommended that patients get periodic blood tests to evaluate the electrolytes, creatinine, and hemoglobin levels that help indicate how well the kidney functions. The physician may also restrict a patient’s salt and protein intake if the patient is experiencing a small amount of kidney insufficiency. Overall, the body adjusts to a singular kidney by a process called concentric hypertrophy. Concentric hypertrophy means that the remaining organ, in this case, the kidney, will enlarge and grow. It will not extend to twice its size, but it will be about 20- 30% larger to continue to do the work of two kidneys. The patient will not feel this enlargement. However, imaging professionals can see it on radiographic evaluations such as ultrasound, MRI, or CT scans.
Once the removal of the diseased or injured kidney has occurred, there are necessary steps a patient must take (under the guidance of his or her physician) to ensure the health of the remaining kidney. These steps include:
- Consistent follow-up with their doctor for exams and testing. Testing sometimes may show decreased renal function, which will then need treatment.
- If one has hypertension, one must make sure they take their medications regularly. One must also ask their physician if they need to change the hypertensive medication class they may be taking to more kidney-friendly ones.
- Drinking at least five cups of water (8 ounces per cup) per day if the patient isn’t also experiencing heart failure.
- Being extra careful and vigilant while doing activities that may cause injury to the remaining organ, such as skiing or contact sports.
- Reduction of salt intake.
- Avoiding the use of anti-inflammatory medications such as Ibuprofen or Naprosyn.
- Refraining from heavy alcohol drinking.
- Quit or do not start smoking.
- Reduction in eating processed foods, especially since they can contain high levels of salt, which can strain the kidneys.
- Taking Calcium and Vitamin D3.
The human body is remarkable in how it can compensate when things don’t function appropriately within it. When it comes to the kidneys, the fact that removing one doesn’t necessarily render us lifeless is a real medical marvel. With a reliable care team and a careful and healthful approach to living post-removal, there are millions of people around the world today who are thriving and healthy on a single (bigger, more vital) kidney.