INSTRUCTIONS FOR SOLITARY KIDNEY PERSON

Nature naturally provides a pair of kidneys even though most people can live a normal life with a single kidney. While this redundancy provides an extra measure of function and provides a “back up”, in fact, one person out of every 600 is born with a single kidney and goes through life without even knowing this.

People may have only one functioning kidney for a variety of reasons.

1. They are born with only one kidney – this is a congenital anomaly.
2. They are born with two kidneys but one is non-functional or barely functions – this is also a congenital anomaly.
3. They are born with two kidneys but one kidney is damaged by infection, obstruction or injury.
4. They are born with two kidneys but one kidney is removed to tumor or injury.
5. They are born with two kidneys but one kidney is donated to someone who needs a transplant.

 

What can damage a single kidney?

1. Infection,
2. Obstruction or other underlying condition.
3. – Single kidney is usually enlarged in compensation and hence more prone for injury
4. Hypertension (high blood pressure).
5. Protein overload.
6. Nephrotoxic drugs

What precautions should be taken?

1. Avoidance of injury: Children (age 5 to adolescence) begin to participate in sports and hobbies. Studies have shown that in general organized sports do not post a great risk to injuring a solitary kidney to a point where it may be lost. However, it is advisable that they should not be promoted towards games which may involve high impact injuries like boxing, football, martial arts, cricket skating etc. In case if they tend to play such games, additional abdominal protector should be provided. They can be encouraged towards games like swimming, badminton, table tennis etc.
2. Over the counter (OTC) Medicines: Following drugs which are available in pharmacy over the counter should be avoided and should be taken only under supervision of physician. Medicines which are commonly used as OTC which can be nephrotoxic are as follows:
   1. Pain killers: aNSAIDs analgesic like ibuprofen, diclofenac, ketorolac
   2. Acidity medicines: Milk of Magnesia, Gelusil etc
   3. Herbal Medicines
3. Dehydration: Since kidneys are prone for dehydration, solitary kidney children should take extra measures to prevent dehydration during loose motions, vomiting or fever episodes such as plenty of fluids, ORS.
4. Use of Contrast agents during CT Scan examination: Such patient should inform the radiologist and technician prior whenever they are advised for CT Scan Examination as certain contrast agents can prove nephrotoxic.
5. Person with solitary kidney should always disclose this fact everytime whenever they approach any physician so that nephrotoxic drugs can be avoided

The Infant – with a solitary kidney should be protected from excess solute or protein. Breast feeding is preferable. Protein should not be arbitrarily restricted. Babies do require protein and other nutrients to grow properly. Consultation is available with a renal nutritionist.

The Young Child – (under age 5) should have minimal cow’s milk and parents should understand modest dietary restriction.

Children – Sports and hobbies restrictions as explained.

Young Adults – need not only to be aware of the same concerns of children, but also should have an understanding of their condition. It is particularly important for them to be able to explain in simple terms which side their functional kidney is located and what happened to the other kidney. As they begin to drive, it may also be advisable to carry some form of notification in their wallets. In accident situations, there may not always be someone around who can explain which side the functional kidney is located. Regular blood pressure measurements should also begin on an annual basis.

Adults – should have yearly blood pressure measurements and may need to consider modest protein restrictions.