What is done when the kidneys are damaged? They filter the blood and send waste to the bladder. They regulate the acid-based balance and they maintain the salt and especially the water balance. They produce hormones, as well. Even if the kidneys are removed, a ruminant animal can be kosher for sacrifice because the stomach does some of this work and thus the animal will not die immediately.
Rachish bar Pappa teaches us that if one kidney is diseased, the animal is a tereifa. The Gemara teaches that in HaAretz this was limited to cases where the disease spread to the white area beneath the animal's loins. Rashi describes this as pus. Others describe the kidneys as beginning to dissolve - they fall apart when they are held up. Or perhaps the kidneys become white, which would indicate serious disease.
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