Q: I am a 28 year old married female. My left kidney is functioning only 5% as per DTPA, MRI test. I was operated for a stag horn stone on the left side two years back. I do a 6 monthly urine examination which shows no albumin till date. Is there any chance of the right kidney being affected as I have not removed the left kidney yet? Is one kidney enough for a life time? Any dos and don'ts for prevention? Chances of the left kidney to be revived? Possibility of transplant as per my case? Will conceiving cause any problem? Will I be able to give normal birth?

A:Regarding the right kidney getting affected: Perhaps the only way the right kidney could be affected by the left in this particular situation would be either insult from longstanding and uncontrolled hypertension or persistently infected left kidney which could cause recurrent infection in right kidney. I do not believe you have any of these conditions. "Is one kidney enough for a life time" is an excellent question and the answer is YES. Individuals live normal healthy life and live as long as others just having a single healthy kidney. Of course, it is important that this solitary kidney is taken care of, which is outlined in the following points. Dos and don'ts for prevention: Most important consideration is prevention of calculus (stone) formation since you have already lost one kidney because of that. You must exercise all the precautions including dietary to prevent a recurrent stone. I have listed stone diet elsewhere in the Q&A section in details. But you may also consult dietitian and nephrologist for details. Additionally, maintaining healthy life style, periodic blood pressure checks, diabetes screens are recommended as well. Strictly control your blood pressure. Staying on low salt diet will help preventing recurrent stone as well as hypertension. Preventing urinary tract infection would be helpful too. Chances of the left kidney to be revived: Unfortunately, there is little that can be done to recover the function of the damaged kidney. Possibility of a transplant: If it ever gets to the point that you require kidney transplant, the single piece of advice would be to perform thorough investigation of stone disease which may already have been done. Since every effort should be made to identify any systemic causes of stone disease which may later affect the transplanted kidney as well. Also, presence of chronic recurrent infection may require removal of infected kidney prior to the transplant. Otherwise, there should be no problems. Regarding conception: Again, you have asked a very good question. If your renal function is normal, I do not see any problems. However, accelerated deterioration of renal function may occur in some patients with chronic renal failure. In general, however, the prognosis depends on the degree of renal dysfunction at the time of conception as well as the presence and extent of comorbidities, specifically, hypertension and proteinuria. Renal function is most likely preserved, especially with mild renal insufficiency. In general, fetal survival rates are good, approaching 95% in most studies. Success rate of pregnancy is decreased and may depend on degree of kidney failure. Complications, including SGA (small for gestational age) infants, preterm labour, and stillbirth, are increased even in mild renal insufficiency. Again, if your renal function is normal, I do not anticipate any of this. In many instances, women with mild degrees of renal insufficiency knowing the risks involved go on to conceive and successfully complete the pregnancy under supervision of special intensive follow-up.