Sport participation for
children with single kidneys
Brad Warady MD
Matthew M Grinsell MD PhD
Pediatric Nephrologist
Children's Mercy Hospital
Kansas City, MO
Fellow Physician
Pediatric Nephrology
University of Virginia
Charlottesville, VA
John M Gatti MD
Victoria F Norwood MD
Assistant Professor of
Surgery and Urology
Director of Minimally
Invasive Urology
Children’s Mercy Hospital
and University of Missouri,
Kansas City School of
Medicine
Kansas City, MO
Associate Professor of
Pediatrics
Chief, Pediatric Nephrology
University of Virginia
Charlottesville, VA
Single kidney and sport
participation
• Increased number of children with
solitary kidneys detected with the
advent of ultrasound
• Survey of the American Society of
Pediatric Nephrology (ASPN)
Brad Warady MD
ASPN survey: Background
• Inconsistencies in the way pediatric
nephrologists, urologists, and
surgeons deal with kids with single
kidneys
• Need to research published data for
evidence on the frequency of
kidney injuries in sports and the
sports involved
Matthew M Grinsell MD
ASPN survey: Results
• Sent out to all ASPN members: 420
nephrologists
• 135 responses, 60% of whom would not
allow a child with a single kidney to play
a contact sport, American football in
particular
• In close agreement with results from
other surveys with different specialties:
– 70% of pediatric urologists
– 60% of sports medicine physicians
Matthew M Grinsell MD
Urology perspective
• Similar survey with 200 pediatric
urologists  70-80% response
• Two-thirds deemed it inappropriate
for children with one kidney to
participate in contact sports
• All recognized that the risk of a
kidney injury was very low: 0-1%
John M Gatti MD
Recommendations from the
American Academy of Pediatrics
• Very vague recommendations
• 1994: “Qualified yes, pending
individual assessment” approach
• Guidelines permit contact sports
but do not provide proper guidance
to the families nor details on the
necessary evaluations
Victoria F Norwood MD
Literature review results
• 37-40 articles dealing with sports injuries
• None addressed single kidneys in sports
• Conclusions were extrapolated from
databases that addressed kidney injuries
in general
• Although American football is thought to
be the biggest culprit, cycling, downhill
skiing, and soccer cause more kidney
injuries
Matthew M Grinsell MD
Literature review results (cont.)
• Only 15 kidney injury publications with
surgical excision or loss of function: 2
from football, others from skiing, biking,
or horseback riding
• One paper reported the incidence of
kidney injury in all sports to be one per
2.5 million kids per year
• Football causes about 3-4.5 brain injuryassociated deaths per year and 5-7.5
irreversible spinal cord injuries
Matthew M Grinsell MD
Should physicians be limiting exercise in
the era of childhood obesity?
• Obese individuals with diabetes will be
the next generation of dialysis
patients
• Obesity alone will become the most
common cause of end-stage renal
disease (ESRD)
• The risk of injuring a kidney is very
low, whereas not exercising could
increase the risk of hypertension,
diabetes, or ESRD to 25-35%
Victoria F Norwood MD
Recommendations
• For perspective, inform families that twothirds of kidney injuries are from motor
vehicle accidents
• Inform families about the small risk
associated with high-velocity sports
(cycling, horseback riding, skiing) but do
not advise against them
• Advise against fighting sports (karate,
kickboxing, etc.)
• Recommend protective gear for all contact
sports (helmets, flak jackets, etc.)
John M Gatti MD
Recommendations (cont.)
• Confirm by ultrasound that the single
kidney is healthy
• Explain to families what would happen
in case of kidney injury (dialysis,
transplant, and lifelong medications)
• Present data on the low incidence of
kidney injuries with sports, and make
a comparison with spinal cord, brain,
or heart injuries
Matthew M Grinsell MD
Recommendations (cont.)
• Recommendations must be evidencebased
• Instead, they are usually based on the
fear of the catastrophic consequences of
losing a solitary kidney
• They do not pay attention to the risk of
that loss
• Must educate people about football vs
other sports
Victoria F Norwood MD