Single Kidney and Sports Participation: Perception Versus Reality

Abstract

Most pediatric nephrologists prohibit contact/collision sports participation by athletes with a single kidney, particularly football. The available evidence suggests that cycling is far more likely to cause kidney injury. In addition, kidney injury from sports is much less common than catastrophic brain, spinal cord, or cardiac injury. Restricting participation of patients with a single, normal kidney from contact/collision sports is unwarranted.

Sport-Related Kidney Injury Among High School Athletes

“…The documented reasons for restricting athletic activities in children with a single kidney usually focus on sequelae of catastrophic loss of the kidney and the risk of comorbidities and death associated with ESRD. 1 It is therefore necessary to have a frank discussion with each family and athlete regarding the potential consequences of a serious renal injury that could occur during sports or other activities. Indeed, the risks of renal injury from nonathletic pursuits are far more common than those from sport participation.…”

“…Physicians should also be reminded that cycling, downhill skiing, and horseback riding (classically referred to as "limited contact sports") are recreational activities that were found to have comparable or higher rates of renal injury in comparison with American football. 1,10 These NATA data afforded a unique opportunity to measure the incidence of kidney injury in organized sports among varsity-level, high school athletes. Because of the large number of athletes monitored over 3 academic years, sufficient data were collected to measure the rate of a rare event, kidney injury.…”

“…The available data are mainly from retrospective studies of trauma databases or small case reports and have been reviewed previously. 1 The available prospective data are limited to a single study on children from 10 counties in western New York State that calculated kidney injury in the pediatric population at 6.9 injuries per million children per year for 1993-2000. 2 There are no published studies, of which we are aware, that use data collected prospectively that describe kidney injury sustained during contact/ collision sports from a large sample of athletes in the pediatric age group.…”

“…[6][7][8] However, some groups have argued that kidney injury during sport is rare and that the recommendation by the AAP is too restrictive and should be updated. 1,9,10 In select instances, restrictions from sport participation applied to athletes with a single kidney have been successfully challenged in the courts. 11,12 It is recognized that those who choose to participate in sport are at risk for sportrelated injury, and injury to the kidney is no exception.…”

Deporte en niños con riñón único

“…Director: Como describí hace un tiempo en un artículo relacionado a problemas renales en la práctica deportiva infantil, y publicado en su Revista 1 , la Academia Americana de Pediatría recomendaba no poner restricciones en realizar deportes sin contacto físico a niños con un riñón solitario, al tiempo que sugería usar el "juicio clínico" cuando se trataba de deportes de contacto y/o colisión 2 . Posteriormente, en carta al director del 2008 3 , agregué las opiniones de un grupo pediátrico norteamericano que analizó la literatura disponible sobre accidentes deportivos en niños, demostrando que la incidencia de trauma renal severo en estas condiciones era de muy baja incidencia, no había necesariamente asociación a deportes de contacto, y que la posibilidad de tener otras lesiones no renales potencialmente letales (traumatismo encéfalo-craneano, daño de médula espinal o contusiones cardíacas severas) eran mayores que el daño renal traumático grave en iguales circunstancias 4 . Recientemente, la Asociación Canadiense de Urología desarrolló una guía de información a padres de niños con riñón único, apoyándose en niveles de evidencia para cada situación …”