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How can the remaining kidney compensate after one kidney is removed from a child?

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Infographic showing estimated lives saved by childhood vaccinations worldwide from 1974 to 2024, with syringe-shaped bars for each disease. Measles tops the list at 93.71 million lives saved, followed by tetanus, whooping cough, and others, for a total of 153.84 million lives saved. — childhood disease and disorder Vaccines and the estimates of lives saved over the period 1974–2024.

When one kidney is removed, the remaining kidney undergoes a process known as a compensatory reaction to meet the body's increased functional demands. This adaptation allows the remaining organ to maintain essential tasks, such as filtering metabolic wastes and balancing water levels.12

The compensatory growth occurs through two primary mechanisms:

Hypertrophy: An increase in the size of individual cells.1
Hyperplasia: An increase in the rate of cell division.1

While these processes lead to an overall increase in the size of the remaining kidney, it is important to note that the total number of nephrons—the kidney's functional filtration units—does not increase. Instead, cell division results in the enlargement of existing glomeruli rather than the creation of new ones. This physiological response ensures that the remaining kidney can effectively manage the workload previously shared by two organs.1