A 2023 meta-analysis covering more than 15.6 million individuals found that renal agenesis occurs in 0.03 per cent of births, with unilateral cases accounting for the majority.
In many children, the functioning kidney naturally enlarges, a process called compensatory hypertrophy, allowing it to perform the work of two kidneys effectively.
"Parents often feel anxious when they learn their child has one kidney, but most of these children grow up without complications," said Dr Shandip Kumar Sinha, Director of Paediatric Surgery and Paediatric Urology at Medanta Hospital, Gurugram.
"With routine monitoring and simple lifestyle precautions, they can enjoy a completely normal childhood, he said.
Studies show that the long-term outlook for children with a solitary functioning kidney is overwhelmingly positive. A comprehensive systematic review analysing 2,684 patients found that while some may develop proteinuria or elevated blood pressure, the vast majority maintain normal kidney function into adulthood.
"Early awareness and regular check-ups make all the difference," said Dr Amit Agarwal, Paediatric Nephrologist at Rainbow Children's Hospital.
"A child with one kidney is not defined by limitations, but by resilience and the confidence we help them build," he said.
Experts emphasised that children with a single kidney do not require restrictive diets or overly cautious lifestyles.
Most sports, including football, running, cycling, and swimming, are safe. Contact sports may require protective gear or individualised medical advice.
"Psychological and emotional support is equally important," said Dr Ankit Prasad, Senior Consultant and Unit Head at Fortis Hospital, Noida.
"Counselling and educating peers can reduce stigma and prevent unnecessary bullying. Hydration, adequate sleep, low-sodium diets, routine physical activity, and regular blood pressure checks are essential," he said.
Dr Ashish Gupta, Senior Consultant Paediatrician at Apollo Hospital, added that unilateral kidney agenesis often goes unnoticed for years and is discovered incidentally.
"Parents should not panic, routine urine protein checks, BP monitoring, and occasional ultrasound are usually all that's needed. What we must avoid are dangerous contact sports, excess salt, and kidney-toxic medications," Gupta said.
Due to advancements in prenatal imaging, many cases of URA are now detected before birth, enabling timely planning and counselling.
Paediatric societies such as the Indian Society of Paediatric Nephrology (ISPN) are calling for broader awareness campaigns to increase understanding of long-term monitoring in families.
Global health organisations also stress that solitary kidneys typically function normally and support a high quality of life, provided blood pressure and proteinuria are monitored over time.
"Parents need reassurance, not fear," Sinha said. "With regular care, especially annual BP checks and urine tests, these children can absolutely lead normal, healthy, and fulfilling lives," he added.
As India continues to strengthen paediatric kidney care awareness and monitoring, experts agree on one message: a single kidney is not a limitation, but a manageable medical condition, and with the right support, children can thrive. PTI PLB ANM ANM