The presence of a solitary kidney in children and adolescents is not a rare condition, and flank injury in this context may result in renal impairment, with subsequent nephrectomy, dialysis or kidney transplantation. Participation in sports activities commonly results in pediatric injuries, and the kidneys are the most frequently affected organs during blunt abdominal trauma. Nonetheless, the incidence of major renal trauma during sports activities, according to pediatric trauma registries in the United States, is still relatively low. Subsequently, there is an ongoing debate in the literature regarding the safety of participation of children with a solitary kidney in sports activities. The literature review presented reveals that the general recommendation has shifted from a formerly restrictive attitude towards a more permissive one, based upon pooled data and calculated risks.