Fate of the Solitary Kidney-Nephrologist Panorama

Abstract

Context: Solitary kidney may be either a congenital solitary kidney (CSK) or an acquired solitary kidney. Patients with both congenital and acquired solitary kidneys are at risk for the progression of chronic kidney disease (CKD). Distinguishing patients at high risk for CKD progression from those at lower risk presents significant challenges. Evidence Acquisition: We conducted a review of the PubMed, Google Scholar, and Science Citation Index databases. The available data were analyzed to determine the effects of lifestyle modifications, nutritional interventions, and pharmacological treatments on the short- and long-term outcomes of patients with unilateral post-nephrectomy. Results: Solitary kidneys, whether congenital (75% of the nephrons of two kidneys) or acquired (50% of the nephrons of two kidneys), have a reduced nephron number, thus remaining at risk for CKD development. Glomerulonephritis and genetic predisposition may accelerate CKD progression in living kidney donors. Additionally, there is an increased risk of preeclampsia and hypertension during pregnancies in living kidney donors. Conclusions: The prognosis for individuals with a solitary kidney is not always benign. Individuals with CSKs, particularly those with ipsilateral congenital anomalies of the kidneys and urinary tract (CAKUT) and/or without compensatory enlargement, may exhibit proteinuria, systemic hypertension, and decreased glomerular filtration rate (GFR). Conversely, individuals with acquired solitary kidneys may experience favorable long-term outcomes but are at a higher risk of developing CKD and end-stage renal disease (ESRD) compared to those with CSK. Lifestyle modifications, nutritional management, and dietary recommendations are advised to enhance the longevity of individuals with solitary kidneys.