When a scan or medical report says that one kidney is not working, it can mean different things.

A person may have two kidneys but one may have very little or no useful function. In another situation, one kidney may be functioning poorly while the other kidney is still doing most of the body's filtering work.

This is different from being born with one kidney, having a kidney surgically removed, or donating a kidney. A person with one healthy functioning kidney can often live normally, but that kidney still needs appropriate monitoring and protection.

The important question is therefore not simply “Is one kidney not working?” but:

Why has the kidney lost function, how much function remains, and is the other kidney healthy?

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized assessment of abnormal kidney function, kidney damage and conditions affecting one or both kidneys.

Can One Kidney Stop Working While the Other Works?

Yes.

Kidney function does not always decline equally in both kidneys.

One kidney may become severely damaged because of:

• Long-standing urinary obstruction

• Kidney stones

• Repeated kidney infections

• Congenital kidney abnormalities

• Kidney dysplasia

• Severe kidney injury

• Scarring

• Certain vascular problems

• Tumors or other structural diseases

• Previous surgery affecting the kidney

In some people, the affected kidney gradually loses function while the other kidney compensates.

NIDDK distinguishes a solitary kidney from a solitary functioning kidney. A solitary functioning kidney means a person may have two kidneys anatomically, but only one is functioning adequately.

What Happens When One Kidney Is Not Functioning?

The answer depends largely on how well the other kidney works.

If the remaining kidney is healthy and provides adequate overall filtration, a person may have few or no symptoms.

However, reduced function in one kidney can become more important if:

• The other kidney is also damaged

• Blood pressure is poorly controlled

• Protein is present in the urine

• There is urinary obstruction

• Diabetes is present

• Recurrent infections occur

• Kidney function declines over time

A functioning kidney can compensate to a significant degree, but it should not be assumed that a non-functioning kidney is harmless in every situation.

What Are the Symptoms of One Kidney Not Working?

A kidney that has gradually lost function may not cause obvious symptoms, particularly when the other kidney is functioning well.

Symptoms may develop because of the underlying condition or because overall kidney function has become reduced.

Possible symptoms include:

• Flank or abdominal discomfort

• Recurrent urinary infections

• Blood in urine

• Changes in urine output

• Foamy urine

• Swelling of the feet or ankles

• High blood pressure

• Fatigue

• Nausea

• Loss of appetite

• Itching

• Muscle cramps

• Breathlessness in advanced kidney dysfunction

People with early or moderate kidney disease may have few symptoms, making blood and urine testing important.

Does One Non-Working Kidney Always Cause Pain?

No.

A kidney can have severely reduced function without causing pain.

Pain is more likely to be related to the cause of kidney damage, such as:

• Kidney stones

• Urinary obstruction

• Infection

• Hydronephrosis

• Inflammation

• Certain structural abnormalities

Therefore, the absence of pain does not prove that the kidney is functioning normally.

Why Does One Kidney Stop Working?

There are several possible explanations.

1. Urinary Obstruction

A long-standing blockage can interfere with urine drainage and damage kidney tissue.

Possible causes include:

• Kidney stones

• Ureteral narrowing

• Enlarged prostate

• Tumors or masses

• Blood clots

• Structural abnormalities

Early treatment of obstruction may sometimes prevent additional kidney damage.

2. Repeated Kidney Infections

Repeated or severe infections can cause kidney inflammation and scarring.

In some patients, recurrent infections are associated with structural urinary problems or obstruction.

3. Kidney Stones

A stone can block urine flow from one kidney.

Prolonged or severe obstruction can impair kidney function, particularly when combined with infection.

4. Congenital Kidney Abnormalities

Some people are born with a kidney that is underdeveloped or abnormal.

Kidney dysplasia can result in a poorly functioning kidney, while the opposite kidney may provide most of the filtration.

5. Loss of Kidney Tissue

Previous surgery, trauma, tumors or severe kidney disease can reduce the amount of functioning kidney tissue.

6. Vascular or Other Kidney Diseases

Diseases affecting the kidney's blood supply or filtering structures can also cause loss of function.

The cause needs to be established rather than assuming that every non-functioning kidney has the same diagnosis.

How Do Doctors Check Whether One Kidney Is Working?

A standard blood test measures overall kidney function, not the individual function of each kidney.

A nephrologist may therefore use several types of tests.

Blood Test for Creatinine and eGFR

Serum creatinine can be used to estimate the overall filtration rate through the eGFR.

eGFR helps determine how well the kidneys are filtering waste from the blood.

Urine Albumin Testing

A urine albumin-to-creatinine ratio, or UACR, can identify albumin leakage.

Persistent albuminuria can indicate kidney damage and is important when monitoring someone with a single functioning kidney.

Ultrasound

A kidney ultrasound can provide information about:

• Kidney size

• Structural abnormalities

• Hydronephrosis

• Stones

• Cysts

• Changes in the urinary tract

CT or Other Imaging

Depending on the situation, CT or another imaging study may be required to investigate stones, obstruction, tumors or structural abnormalities.

Tests of Individual Kidney Function

When doctors need to know how much each kidney contributes separately, specialized functional imaging or nuclear medicine studies may be considered.

The choice depends on the clinical question.

Can a Non-Working Kidney Start Working Again?

Sometimes—but it depends on why the kidney has lost function.

If the apparent loss of function is caused by a reversible problem, improvement may be possible.

Examples include:

• Temporary obstruction

• Certain acute kidney injuries

• Severe dehydration

• Some infections

• Certain medication-related injuries

However, a kidney that has extensive permanent scarring or longstanding irreversible damage may not regain meaningful function.

This is why identifying the cause and duration of kidney dysfunction is important.

What Is the Treatment for One Kidney Not Working?

There is no single medicine that can make every non-functioning kidney recover.

Treatment is directed toward the cause and the amount of remaining kidney function.

If a Blockage Is Present

The urinary obstruction may need to be relieved.

Depending on the cause, treatment may involve a stent, nephrostomy, stone procedure or treatment of another obstruction.

If a Stone Is Responsible

The stone may need medical management or removal depending on its size, location, obstruction, infection and effect on kidney function.

If Infection Is Present

An appropriate antimicrobial treatment may be required.

An infected obstructed urinary tract can require urgent drainage as well as treatment of the infection.

If Blood Pressure Is High

Blood-pressure management is important for protecting remaining kidney function.

Certain medicines may provide kidney-protective benefits in appropriate patients, particularly when albuminuria is present.

If Diabetes Is Contributing

Good diabetes management can help reduce the risk of further kidney damage.

If Permanent Kidney Damage Is Present

The focus may shift toward protecting the remaining functioning kidney and monitoring overall kidney health.

Does a Non-Working Kidney Need to Be Removed?

Not automatically.

A kidney with little or no function does not necessarily need surgical removal.

The decision depends on factors such as:

• Recurrent infection

• Persistent pain

• Repeated bleeding

• Stones

• Severe obstruction

• Suspicion of a tumor

• High blood pressure related to the affected kidney

• Overall kidney function

• The condition of the opposite kidney

Some non-functioning kidneys can simply be monitored when they are not causing complications.

Surgery is considered only when the expected benefits outweigh the risks.

Can You Live Normally With One Working Kidney?

Many people can live healthy lives with one functioning kidney.

People may have one functioning kidney because they were born with one kidney, donated a kidney, underwent nephrectomy, or have one kidney that does most of the body's filtering work.

However, a single functioning kidney should be protected and monitored.

NIDDK recommends monitoring kidney function with blood and urine testing and controlling blood pressure in people with a solitary kidney.

What Tests Should Be Monitored With One Working Kidney?

Depending on the individual situation, monitoring may include:

• eGFR

• Serum creatinine

• Urine albumin-to-creatinine ratio

• Urinalysis

• Blood pressure

• Blood glucose when relevant

• Electrolytes

• Kidney imaging when indicated

Following the trend over time is often more useful than interpreting a single creatinine or eGFR result.

Can One Working Kidney Handle the Body's Needs?

In many people, yes.

A healthy functioning kidney can provide sufficient filtration for normal life.

However, the amount of kidney function varies between individuals. Having one functioning kidney does not mean that the person can ignore kidney health.

Factors that can threaten the remaining kidney include:

• Uncontrolled hypertension

• Diabetes

• Significant proteinuria

• Repeated acute kidney injury

• Severe dehydration

• Certain kidney-toxic medicines

• Recurrent obstruction

• Serious infections

Protecting the remaining kidney becomes especially important because loss of its function can result in kidney failure requiring kidney replacement therapy.

Lifestyle Habits That Help Protect One Functioning Kidney

There is no special “kidney cleansing” routine that can restore a permanently damaged kidney.

Instead, kidney protection generally focuses on long-term health.

Control Blood Pressure

High blood pressure can damage the blood vessels within the functioning kidney.

Regular monitoring and appropriate treatment are important.

Manage Diabetes

If you have diabetes, follow your healthcare professional's treatment plan and monitor blood glucose as recommended.

Avoid Unnecessary Painkillers

Some NSAID pain medicines can harm kidney function, particularly in people who already have kidney disease or are dehydrated. Discuss regular painkiller use with your doctor.

Avoid Unverified Supplements

Herbal “kidney cleanses” and bodybuilding or weight-loss supplements are not automatically safe for someone with reduced kidney function.

Maintain a Kidney-Appropriate Diet

Dietary requirements depend on kidney function, potassium, phosphorus, protein needs and other medical conditions.

Do not unnecessarily follow a highly restrictive diet without professional advice.

Stay Appropriately Hydrated

Fluid requirements vary.

A person with one functioning kidney should not automatically drink excessive amounts of water, particularly if kidney function is reduced or fluid restriction has been prescribed.

What Happens If the Other Kidney Also Becomes Weak?

This is an important concern when one kidney is already non-functioning.

If the remaining kidney develops significant disease, overall kidney function can decline.

Depending on severity, treatment may include:

• Medical management

• Dietary and lifestyle adjustments

• Treatment of the underlying disease

• Management of complications

• Dialysis when kidney failure develops

• Kidney transplantation for appropriately selected patients

Kidney failure is generally defined when kidney function falls to less than about 15% of normal, although treatment decisions are based on the full clinical situation rather than a single number.

When Should You See a Nephrologist?

Specialist evaluation is particularly useful when:

• A scan shows one kidney is severely damaged or non-functioning

• Creatinine is abnormal

• eGFR is declining

• Protein is detected in urine

• Blood pressure is difficult to control

• There are recurrent kidney infections

• Kidney stones or obstruction are present

• The functioning kidney has structural abnormalities

• There is unexplained swelling

• Urine output changes

A nephrologist can assess overall kidney function, identify risk factors and help develop a plan to protect the functioning kidney.

When Is One Kidney Not Working an Emergency?

The finding itself is not always an emergency, especially if it represents an old, stable condition.

Urgent medical assessment is needed when kidney dysfunction is accompanied by:

• Very little or no urine

• Severe flank pain

• Fever or chills with urinary symptoms

• Severe breathlessness

• Rapidly increasing swelling

• Confusion

• Persistent vomiting

• Sudden deterioration in health

An obstructed urinary tract with infection can become particularly serious and requires prompt medical attention.

Kidney Function Evaluation at Prabhakar Bhurke Clinic

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

Depending on the clinical situation, assessment may include:

• Review of previous kidney reports

• Creatinine and eGFR evaluation

• Urine protein or albumin testing

• Blood-pressure assessment

• Ultrasound and imaging review

• Evaluation for stones or obstruction

• Assessment of recurrent infections

• Evaluation of congenital or structural kidney problems

• Monitoring of the functioning kidney

• Management of chronic kidney disease

• Dialysis and kidney-transplant evaluation when clinically appropriate

The objective is to determine why one kidney has lost function and how the remaining kidney can best be protected.

Frequently Asked Questions

Can one kidney stop working while the other kidney works normally?

Yes. One kidney can have severely reduced function while the opposite kidney provides most of the body's filtration. The cause and remaining kidney function need to be evaluated.

What are the signs that one kidney is not working?

There may be no specific symptoms. When kidney function or the underlying disease causes problems, symptoms can include swelling, changes in urine, high blood pressure, fatigue, nausea or pain depending on the cause.

Can a non-functioning kidney recover?

Recovery is possible when the apparent loss of function is caused by a reversible problem. Longstanding scarring or severe permanent damage generally cannot simply be reversed.

Does one non-working kidney mean dialysis is needed?

No. If the other kidney provides adequate overall function, dialysis may not be necessary. Dialysis is considered when overall kidney function becomes severely inadequate and clinical indications are present.

Can you live with one functioning kidney?

Yes. Many people live normal lives with one functioning kidney, but regular monitoring of kidney function, urine albumin and blood pressure is important.

Does a non-functioning kidney always need to be removed?

No. Removal depends on whether the kidney is causing complications such as recurrent infection, pain, bleeding, obstruction, stones or other significant problems.

How do doctors know which kidney is working?

Ultrasound or CT can show kidney structure, while specialized functional imaging can sometimes estimate the contribution of each kidney separately. Overall kidney function is assessed with blood and urine tests.

What should I do if my report says one kidney is not functioning?

Do not assume that the kidney is permanently lost based on one report. Discuss the imaging and laboratory findings with a nephrologist or appropriate urinary specialist to determine the cause, remaining function and next steps.

Conclusion

A diagnosis of one kidney not working does not automatically mean that the person has kidney failure or needs dialysis.

The key issues are why the kidney has lost function, whether the loss is reversible, how well the other kidney is functioning and whether complications are present.

Some people have a non-functioning kidney for many years without major problems because the opposite kidney provides adequate filtration. Others may require treatment for obstruction, stones, infection or another underlying disease.

Regular monitoring of eGFR, urine albumin and blood pressure can help protect the remaining functioning kidney.

If an imaging report has shown that one kidney is not working or is functioning poorly, specialist evaluation can help determine whether treatment, observation or further testing is appropriate.

For individualized kidney evaluation and long-term kidney care, 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 be considered a substitute for medical diagnosis, treatment or individualized medical advice. “One kidney not working” can describe several different conditions, including congenital abnormalities, obstruction, infection, stones, scarring, vascular disease or other kidney disorders. A non-functioning kidney does not automatically mean kidney failure or a need for dialysis. Treatment depends on the cause, the amount of remaining kidney function and the health of the opposite kidney. Do not start, stop or change medicines, supplements, fluid intake or diet based solely on this article. Seek urgent medical attention for very little or no urine, severe flank pain, fever or chills with urinary symptoms, severe breathlessness, confusion, rapidly worsening swelling or sudden deterioration in health. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized assessment.