Living with One Kidney: How to Stay Healthy and Protect Your Kidney for Life

Most people are born with two kidneys, but living with just one is entirely possible with proper care and monitoring. Whether you have one kidney due to donation, birth condition, surgical removal, or injury, understanding how to maintain kidney health is essential for your long-term wellbeing.

Understanding Life with a Single Kidney

How Your Body Adapts

When you have only one kidney, your body undergoes a remarkable adaptation process called compensatory hypertrophy. Within weeks of losing a kidney, the remaining organ typically enlarges by 30-50% and increases its filtration capacity. This natural response allows a single kidney to handle the workload normally shared by two kidneys.

A 2024 study published in Nephrology examined renal transplant recipients and found that 62.9% experienced an increase in kidney length within the first year post-transplant. This increase in kidney size, indicative of compensatory hypertrophy, was associated with enhanced estimated glomerular filtration rate (eGFR), suggesting that the kidney adapts structurally and functionally to meet the body's demands after transplantation.

What Your Kidneys Do

Your kidneys perform several critical functions:

• Filter waste products and excess fluid from your blood

• Balance electrolytes and minerals

• Help regulate blood pressure

• Support red blood cell production

• Activate vitamin D for bone health

• Regulate acid-base balance

When you have one kidney, these functions remain the same—your remaining kidney simply works harder to maintain them.

Risk Factors and Long-Term Considerations

Research shows that living with one kidney may slightly increase your risk for:

• Hypertension (high blood pressure): Your single kidney may have to work harder to filter blood, potentially affecting blood pressure regulation.

• Proteinuria: The presence of excess protein in urine, which can indicate kidney stress. For a deeper look at this, read our article on Protein in Urine.

• Reduced kidney function over time: Usually mild but may progress gradually over decades.

• Increased vulnerability: Without a "backup" kidney, any injury or disease affecting your remaining kidney carries greater significance.

A 2023 meta-analysis published in BMC Nephrology reviewed several long-term studies on living kidney donors and found that while donors may have a slightly higher risk of developing serious kidney problems like end-stage kidney disease compared to non-donors, the overall risk remains very low—especially for healthy individuals. The researchers emphasized that living donation is generally safe, but highlighted the importance of ongoing monitoring and more long-term research to fully understand any potential risks.

Protecting Your Single Kidney: Essential Guidelines

Physical Protection

Your kidney is located in your lower back area, protected partially by your lower ribs. Since you only have one kidney, physical protection becomes more important:

• Consider avoiding high-contact sports such as football, boxing, hockey, and martial arts

• If you do participate in contact sports, wear appropriate kidney protection equipment

• Always wear seatbelts in vehicles

• Take precautions to avoid falls, especially if you're at higher risk

• Be cautious during activities with high impact or fall potential

According to the National Kidney Foundation, about 1 in 750 athletes has only one kidney, and many of them safely participate in sports at amateur and even professional levels. While having one kidney does not automatically prevent athletic activity, studies suggest that kidney injuries occur in only about 0.01% to 0.05% of all sports-related injuries.

Read our Kidney Health Guide for full protection strategies.

Nutrition for Kidney Health

A kidney-friendly diet focuses on balance rather than severe restriction for most people with a single healthy kidney:

• Stay hydrated: Aim for 2-3 liters (8-12 cups) of fluid daily, adjusting for activity level and climate

• Moderate protein intake: Excessive protein can strain your kidney; aim for 0.8g of protein per kg of body weight

• Reduce sodium: Limit to less than 2,300mg daily (about 1 teaspoon of salt)

• Choose heart-healthy foods: What's good for your heart is generally good for your kidney

• Emphasize plant-based foods: Fruits, vegetables, whole grains, and legumes provide nutrients without excess waste products

If your kidney function begins to decline, your doctor may recommend additional dietary modifications regarding potassium, phosphorus, and fluid intake.

You may also benefit from using Urine Protein Test Strips to monitor your health at home.

Medication Safety

Many medications are filtered or metabolized by your kidneys, making medication safety particularly important:

• Always inform healthcare providers that you have one kidney

• Use caution with NSAIDs like ibuprofen and naproxen—occasional use is generally acceptable for those with normal kidney function, but regular use can cause damage

• Avoid nephrotoxic drugs when alternatives exist

• Request kidney function monitoring when taking necessary medications with kidney risk

• Follow dosing guidelines carefully as some medications require adjustment based on kidney function

Medications requiring special caution:

• NSAIDs (ibuprofen, naproxen)

• Certain antibiotics (gentamicin, tobramycin)

• Some blood pressure medications

• Contrast dyes used in imaging studies

• Certain chemotherapy drugs

Alcohol Consumption

Research on alcohol's direct effects on kidney health shows moderate consumption likely poses minimal risk to those with normal kidney function. However, with only one kidney, caution is advised:

• Limit alcohol to no more than 1 drink daily for women and 2 for men

• Avoid binge drinking completely

• Stay well-hydrated when consuming alcohol

• If you have any degree of kidney dysfunction, discuss alcohol use with your healthcare provider

Curious about the effects of alcohol? See Does Alcohol Cause Kidney Stones?

Exercise Recommendations

Regular physical activity supports kidney health by improving circulation, maintaining healthy blood pressure, and managing weight. For those with one kidney:

• Focus on moderate-intensity exercise: Walking, swimming, cycling, and strength training are excellent options

• Stay hydrated during and after workouts

• Consider wearing kidney protection for activities with moderate fall or impact risk

• Avoid extreme dehydration during intense exercise or in hot conditions. Hydration is crucial—learn how to spot dehydration.

Medical Monitoring and Healthcare

Recommended Screening Schedule

Regular monitoring is essential for early detection of any kidney issues:

Annual checkups should include:

• Blood pressure measurement

• Blood tests (creatinine, BUN, eGFR)

• Urinalysis (checking for protein and blood)

• Review of medications and supplements

Learn more in our guide to Understanding Creatinine Levels.

Additional monitoring during:

• Pregnancy

• Serious illness

• When starting new medications

• After age 50, when kidney function naturally begins to decline

Explore our Complete Guide to At-Home Kidney Function Tests for home monitoring tips.

Warning Signs to Watch For

Contact your healthcare provider if you experience:

• Significant changes in urination patterns

• Persistent foamy or bloody urine

• Unexplained swelling in hands, feet, or face

• Fatigue that doesn't improve with rest

• Persistent high blood pressure

Special Considerations

Pregnancy with One Kidney

Women with a single kidney can have healthy pregnancies, though they require additional monitoring:

• More frequent blood pressure checks

• Regular urine tests for protein

• Kidney function assessment each trimester

• Closer monitoring for preeclampsia

Research published in Frontiers in Transplantation highlighted that while women with a single kidney, including living kidney donors, can have successful pregnancies, they may face an increased risk of hypertensive disorders. However, the absolute risk remains small, and fetal and neonatal outcomes were generally comparable to those in women with two kidneys.

Children with One Kidney

Children born with a single kidney (renal agenesis) or who lose a kidney early in life generally adapt well:

• Regular monitoring throughout growth and development

• Age-appropriate guidance about physical activities and sports

• Education about kidney protection as they mature

• Transition plan to adult kidney care

Aging with One Kidney

As we age, kidney function naturally declines. With only one kidney:

• More frequent monitoring may be recommended after age 60

• Medication reviews become increasingly important

• Blood pressure control becomes more critical

• Dietary adjustments may be necessary as kidney function changes

When to Seek Additional Care

If your kidney function begins to decline significantly (generally when eGFR drops below 60), your doctor may recommend:

• Consultation with a nephrologist (kidney specialist)

• More frequent monitoring

• Dietary modifications

• Blood pressure optimization

• Careful management of any diabetes or cardiovascular conditions

In rare cases where a single kidney fails, treatment options include dialysis or kidney transplantation.

If you’ve experienced UTIs, read about Why Does UTI Cause Proteinuria?

The takeaway

Living with one kidney is completely manageable—but not something to ignore.

With regular checkups, healthy habits, and a proactive mindset, you can stay strong and avoid complications. One kidney, when protected, can carry you through a full, vibrant life.

Your next steps with Ribbon Checkup

If you’re living with one kidney, consider taking an at-home kidney health test to track your creatinine, GFR, and protein levels—all in the comfort of home. 

Frequently Asked Questions

1. Can I live a normal, healthy life with one kidney?
Yes. Most people with one healthy kidney live normal, active lives. The remaining kidney usually grows slightly and increases its function to compensate for the missing one.

2. Are there any long-term health risks I should be aware of?
There may be a slightly increased risk of high blood pressure, protein in the urine, or reduced kidney function over many years. However, with regular monitoring and healthy lifestyle habits, these risks are manageable.

3. Is it safe to exercise or play sports with one kidney?
Yes, exercise is encouraged. For high-impact or contact sports, such as football or martial arts, wearing kidney protection is recommended to minimize injury risk.

4. What should I eat or avoid to protect my kidney?
Stick to a balanced diet that’s low in processed foods and sodium. Avoid excessive protein or over-the-counter painkillers without medical advice. Staying well-hydrated is also important.

5. How often should I have my kidney function checked?
If your kidney is healthy, most experts recommend an annual check-up that includes blood pressure, urine tests, and kidney function tests like eGFR.

Written by Abel Tamirat, MD
Dr. Abel Tamirat is a licensed General Practitioner and ECFMG-certified international medical graduate with over three years of experience supporting U.S.-based telehealth and primary care practices. As a freelance medical writer and Virtual Clinical Support Specialist, he blends frontline clinical expertise with a passion for health technology and evidence-based content. He is also a contributor to Continuing Medical Education (CME) programs.

References

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Living With One Kidney. (2025, May 18). Retrieved May 19, 2025, from National Kidney Foundation website: https://www.kidney.org/kidney-topics/living-one-kidney 

Ronin, M. (2024, May 8). What Are the Side Effects of Living with One Kidney? Retrieved May 19, 2025, from National Kidney Registry website: https://www.kidneyregistry.com/for-donors/kidney-donation-blog/what-are-the-side-effects-of-living-with-one-kidney/ 

Schreuder, M. F., & Nauta, J. (2007). Prenatal programming of nephron number and blood pressure. Kidney International, 72(3), 265–268. https://doi.org/10.1038/sj.ki.5002307 

The. (2020, March 9). Living with One Kidney: What to Know. Retrieved May 19, 2025, from Healthline website: https://www.healthline.com/health/kidney-health/can-you-live-with-one-kidney 

Westland, R., Schreuder, M. F., Goudoever, van, Sanna-Cherchi, S., & A.E, J. (2013). Clinical Implications of the Solitary Functioning Kidney. Clinical Journal of the American Society of Nephrology, 9(5), 978–986. https://doi.org/10.2215/cjn.08900813