A kidney that has stopped working does not automatically have to be removed.

Whether a nonfunctioning or severely damaged kidney should remain in the body or be removed depends on why it has stopped working, whether it is causing complications, how much function remains, and how well the other kidney is working.

A kidney may lose function because of long-standing obstruction, repeated infections, kidney stones, congenital abnormalities, severe scarring, blood-supply problems or other diseases.

In some people, the damaged kidney can be monitored without surgery. In others, removal may be considered because the kidney is repeatedly infected, painful, bleeding or causing other complications. Clinical guidance from NHS urology services lists pain, bleeding, recurrent infection and a kidney that has stopped working among situations in which nephrectomy may be considered.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized assessment of kidney function and helps determine whether a nonfunctioning kidney requires further treatment or specialist surgical evaluation.

What Does “One Kidney Has Failed” Actually Mean?

The phrase “one kidney has failed” can mean different things.

A kidney may have:

• Severely reduced function

• Almost no measurable function

• Complete loss of function

• Permanent structural damage

• Temporary loss of function

• Obstruction causing reduced drainage

• Damage from repeated infection or stones

Therefore, a report describing a kidney as “poorly functioning” does not by itself mean that the kidney should be removed.

Doctors first try to determine whether the loss of function is reversible, potentially recoverable or permanently established.

Can You Live Normally With One Working Kidney?

Yes. One healthy kidney can often provide sufficient filtration for the body's needs.

People can live with one functioning kidney, including individuals who were born with one kidney, donated a kidney or had one kidney removed.

However, the remaining kidney needs to be assessed before removing a severely damaged kidney.

Doctors may evaluate:

• Serum creatinine

• eGFR

• Urine protein or albumin

• Blood pressure

• Kidney imaging

• Overall medical condition

The aim is to make sure that removing one kidney will leave adequate overall kidney function.

Why Does One Kidney Stop Working?

A kidney can lose function for many different reasons.

Long-Standing Urinary Obstruction

Repeated or prolonged blockage of urine flow can damage kidney tissue.

Possible causes include:

• Kidney stones

• Ureteric narrowing

• Enlarged prostate

• Structural abnormalities

• Tumors or masses

If obstruction is identified early, relieving it may sometimes preserve or improve kidney function.

Recurrent Kidney Infections

Repeated severe infections can produce scarring and progressive loss of kidney function.

A severely damaged kidney that remains chronically infected may sometimes become a reason for nephrectomy.

Kidney Stones

Large or recurrent stones can cause obstruction, infection and progressive damage.

In some advanced cases, extensive stone disease may leave a kidney with very little useful function.

Congenital Kidney Abnormalities

Some people are born with a kidney that is small, malformed or poorly functioning.

The treatment depends on the anatomy, symptoms, complications and function of the other kidney.

Severe Kidney Damage

Trauma, vascular problems, inflammatory disease or other serious conditions can sometimes result in permanent loss of kidney function.

Kidney Tumors

A kidney may need to be removed when cancer is present, depending on the type, size, location and stage of the tumor.

Cancer-related nephrectomy is different from removal of a kidney simply because it has stopped functioning.

Does a Nonfunctioning Kidney Cause Symptoms?

Not always.

Some people have a kidney with very little function and experience no obvious symptoms.

Others may develop:

• Recurrent urinary infections

• Flank or abdominal pain

• Blood in the urine

• Fever

• Kidney stones

• Urinary obstruction

• High blood pressure

• Recurrent episodes of discomfort

A nonfunctioning kidney can sometimes remain unnoticed until imaging is performed for another reason.

Therefore, symptoms alone cannot determine whether a kidney needs to be removed.

What Tests Show Whether One Kidney Is Working?

The doctor may need to determine how much each kidney contributes individually, rather than looking only at the total creatinine or eGFR.

Ultrasound

An ultrasound can provide information about:

• Kidney size

• Structural abnormalities

• Swelling

• Hydronephrosis

• Stones

• Other abnormalities

CT or MRI

Depending on the situation, cross-sectional imaging may provide more detailed information about kidney structure, stones, obstruction, masses or surrounding anatomy.

Nuclear Renal Scan

In selected patients, a nuclear medicine renal scan can estimate the relative function of each kidney.

This can be particularly useful when one kidney appears severely damaged and doctors are considering whether removal is appropriate.

Blood Tests

Overall kidney function may be assessed using:

• Creatinine

• eGFR

• Urea

• Electrolytes

Urine Tests

Urinalysis and urine albumin or protein testing can provide additional information about the functioning kidney and overall kidney health.

When Can a Failed Kidney Be Left in Place?

A kidney with very little function does not necessarily have to be removed if it is not causing significant problems.

Observation may be considered when:

• There is no recurrent infection

• There is no significant pain

• There is no problematic bleeding

• There is no persistent obstruction requiring removal

• There is no concerning tumor

• The patient is clinically stable

• The treating specialists believe monitoring is appropriate

The decision must be individualized.

The presence of low kidney function alone is not always an indication for nephrectomy.

When Might Kidney Removal Be Recommended?

Nephrectomy may be considered when a severely damaged or nonfunctioning kidney is associated with significant complications.

Potential reasons include:

Recurrent Infection

A chronically infected, severely damaged kidney may continue to cause repeated infections despite appropriate treatment.

Persistent Pain

Some nonfunctioning kidneys can cause ongoing flank or abdominal pain that does not resolve with appropriate treatment.

Recurrent Bleeding

Bleeding from a severely damaged kidney can be an indication for removal in selected cases.

Severe Stone-Related Damage

A kidney extensively damaged by stones and associated infections may sometimes require nephrectomy.

Suspected or Confirmed Cancer

A kidney tumor may require partial or complete surgical removal depending on the circumstances.

Other Complications

The urologist may recommend removal when the kidney is causing complications that cannot be adequately controlled through less invasive treatment.

Does Removing a Failed Kidney Improve Kidney Function?

Removing a nonfunctioning kidney does not automatically improve the function of the remaining kidney.

The purpose of nephrectomy is usually to address a problem caused by the damaged kidney, such as recurrent infection, pain, bleeding, severe stone-related disease or cancer.

If the remaining kidney is healthy, it may continue to provide the body's required filtration after surgery.

If the remaining kidney already has impaired function, the risks and benefits of surgery need particularly careful consideration.

Can a Failed Kidney Recover Without Removal?

Sometimes the kidney described as “failed” may actually have reduced function rather than irreversible complete failure.

For example, kidney function may be affected by:

• Urinary obstruction

• Severe dehydration

• Infection

• Certain medicines

• Acute kidney injury

• Reduced blood supply

Some causes of acute kidney dysfunction can improve when treated promptly.

This is why doctors should establish whether the kidney has permanent structural damage before deciding that removal is necessary.

What Happens If the Other Kidney Is Healthy?

When one kidney is permanently nonfunctional and the other kidney works adequately, a person may be able to live with the remaining kidney.

After nephrectomy, follow-up generally focuses on protecting the remaining kidney.

Monitoring may include:

• Blood pressure

• Creatinine and eGFR

• Urine albumin

• Diabetes control when applicable

• Medication review

• General kidney-health monitoring

A healthy remaining kidney can compensate for the loss of the other kidney, but regular medical follow-up remains important.

What If Both Kidneys Have Reduced Function?

This situation is very different.

If the other kidney is also significantly impaired, removing a poorly functioning kidney may have a greater effect on total kidney function.

Before surgery, the medical team may therefore assess:

• Total eGFR

• Individual kidney function

• Proteinuria

• Blood pressure

• Electrolytes

• Diabetes and cardiovascular health

• Risk of postoperative kidney failure

In selected patients, poor function of the remaining kidney may increase the possibility of requiring dialysis after nephrectomy.

What Is Nephrectomy?

Nephrectomy is surgery to remove a kidney.

Depending on the reason for surgery, it may involve:

Simple Nephrectomy

This may be used for a severely damaged or nonfunctioning kidney that is causing problems but is not being removed for suspected cancer.

Radical Nephrectomy

This is generally performed for certain kidney cancers and involves removal of the kidney with surrounding tissues according to the surgical plan.

Partial Nephrectomy

Only part of the kidney is removed when preservation of functioning kidney tissue is possible and appropriate, particularly for selected kidney tumors.

The type of operation depends on the diagnosis and anatomy.

How Is Kidney Removal Performed?

Nephrectomy may be performed using:

• Laparoscopic surgery

• Robotic-assisted surgery in selected centers

• Open surgery when necessary

Laparoscopic nephrectomy uses several small incisions and specialized instruments rather than one large incision.

The appropriate approach depends on the reason for surgery, previous operations, anatomy, kidney condition and surgeon assessment.

What Are the Risks of Nephrectomy?

Kidney removal is a major surgical procedure and carries potential risks.

These can include:

• Bleeding

• Infection

• Pain

• Blood clots

• Anaesthetic complications

• Injury to nearby organs or blood vessels

• Wound complications

• Temporary reduction in kidney function

• Rarely, need for dialysis if the remaining kidney cannot provide sufficient function

The individual risk depends on overall health, kidney function, age, surgical approach and the reason for nephrectomy.

Recovery After Kidney Removal

Recovery varies according to the surgical technique and the patient's overall condition.

After nephrectomy, the medical team may monitor:

• Urine output

• Creatinine

• Electrolytes

• Blood pressure

• Wound healing

• Pain control

• Signs of infection

Activity restrictions and return to normal activities depend on the procedure and individual recovery.

Long-term care focuses on protecting the remaining kidney when only one functioning kidney remains.

How Can You Protect the Remaining Kidney?

If you have one functioning kidney, kidney protection becomes particularly important.

Helpful measures may include:

• Monitor blood pressure regularly.

• Control diabetes if present.

• Attend recommended kidney-function tests.

• Avoid unnecessary NSAID painkillers.

• Inform healthcare professionals that you have one functioning kidney.

• Take prescribed medicines as directed.

• Maintain an appropriate diet.

• Follow individualized fluid advice.

• Avoid unverified herbal or “kidney cleansing” products.

• Seek medical attention for persistent urinary infections or obstruction.

Do not make major dietary or fluid changes without professional guidance.

When Should You Get a Nonfunctioning Kidney Evaluated?

A specialist evaluation is especially important if imaging shows that one kidney is:

• Very small

• Severely scarred

• Hydronephrotic

• Poorly functioning

• Nonfunctioning

• Repeatedly infected

• Associated with large or recurrent stones

The next step should be determining why the kidney has lost function and whether it is causing a problem.

Kidney Function Assessment at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized assessment for patients with reduced or abnormal kidney function.

Depending on the clinical situation, evaluation may include:

• Review of previous kidney-function reports

• Creatinine and eGFR assessment

• Urine testing

• Blood-pressure evaluation

• Review of ultrasound, CT or MRI findings

• Assessment of kidney stones or urinary obstruction

• Evaluation of recurrent kidney infections

• Assessment of proteinuria

• Review of individual kidney function when relevant

• Kidney-protection planning for patients with one functioning kidney

• Coordination with a urologist when nephrectomy or another surgical procedure is being considered

When kidney removal is being discussed, understanding the function of both kidneys and the condition of the remaining kidney is essential.

Frequently Asked Questions

If one kidney fails, does it need to be removed?

No. A nonfunctioning kidney does not automatically need removal. Surgery may be considered if the kidney causes recurrent infection, persistent pain, bleeding, severe stone-related complications, cancer or other significant problems.

Can you live with one kidney?

Yes. Many people can live with one functioning kidney, provided it is healthy enough to maintain adequate kidney function.

What happens if one kidney is not working but the other is healthy?

The functioning kidney may provide enough filtration for normal body needs. Doctors will usually monitor kidney function, blood pressure and urine protein over time.

Can a nonfunctioning kidney cause infection?

Yes. A severely damaged kidney may sometimes be associated with recurrent or chronic infection, particularly when structural abnormalities or stones are present. In selected cases, removal may be considered.

Can a dead kidney cause pain?

A kidney with little or no function may cause pain in some patients, particularly when associated with infection, stones, obstruction or other complications. Pain is not present in everyone.

How do doctors know whether a kidney has stopped working?

Blood tests assess overall kidney function, while imaging and, when necessary, a nuclear renal scan can help determine the structure and individual contribution of each kidney.

Can a kidney that has stopped working start working again?

If the kidney has permanent structural damage and no meaningful function remains, recovery is unlikely. However, some apparently severe reductions in kidney function can be caused by potentially reversible problems, so the cause should be evaluated before concluding that the damage is permanent.

Is kidney removal the same as dialysis?

No. Nephrectomy is an operation to remove a kidney. Dialysis is a treatment that replaces some kidney filtration functions when the body's overall kidney function is insufficient.

Will removing one kidney cause kidney failure?

Not necessarily. If the remaining kidney is healthy and provides adequate filtration, many people can live with one kidney. However, the risk depends on the function of the remaining kidney and the person's overall health.

Conclusion

If one kidney fails, it does not automatically need to be removed. The decision depends on whether the kidney has any recoverable function, why it stopped working, whether it is causing pain or recurrent infection, whether stones or obstruction are present, and how well the other kidney functions.

Some nonfunctioning kidneys can be safely monitored when they are not causing significant complications. In other situations, nephrectomy may be considered to address persistent infection, pain, bleeding, severe stone-related damage or certain tumors.

Before kidney removal is considered, doctors may evaluate overall kidney function and, when necessary, determine the separate contribution of each kidney. The health of the remaining kidney is particularly important because it may need to provide the body's filtration after surgery.

For individualized evaluation of reduced kidney function and guidance when a nonfunctioning kidney is being considered for treatment, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not replace medical diagnosis, treatment or individualized surgical advice. A kidney described as “failed,” “nonfunctioning” or “poorly functioning” does not automatically require removal. The decision depends on the cause, remaining kidney function, symptoms, infection, obstruction, stones, bleeding, cancer risk and overall health. Nephrectomy is a major operation and should be considered only after appropriate evaluation by qualified kidney and urological specialists. Do not assume that a damaged kidney must be removed or delay treatment based solely on this article. Consult Dr. Sandip Prabhakar Bhurke and the appropriate urology/nephrology team for an individualized assessment.