Nephrectomy (kidney removal)

Overview

Nephrectomy (nuh-FREK-tuh-me) is a surgery to remove all or part of a kidney. Most often, it's done to treat kidney cancer or to remove a tumor that isn't cancerous. The doctor who does the surgery is called a urologic surgeon.

There are two main types of this procedure. Radical nephrectomy removes an entire kidney. Partial nephrectomy removes part of a kidney and leaves healthy tissue in place.

Surgeons have various ways to reach the kidney. The surgery can be done through a single cut in the stomach area or the side. This is called open nephrectomy. More often, the procedure is done through a series of small cuts made in the stomach area. This is called laparoscopic nephrectomy.

Sometimes, a robotic system is used during laparoscopic procedures. In robotic surgery, the surgeon sits at a computer console near the operating table and controls surgical tools and a camera attached to robotic arms.

Why it's done

The most common reason for a nephrectomy is to remove a tumor from the kidney. These tumors are often cancer, but sometimes they're not. In other cases, nephrectomy can help treat a diseased or damaged kidney. It's also used to remove a healthy kidney from an organ donor for transplant into a person who needs a working kidney.

Kidney function

Most people have two kidneys — fist-sized organs located near the back of the upper stomach area, also called abdomen. The kidneys:

• Filter wastes and extra fluid from the blood.
• Make urine.
• Maintain proper levels of minerals in the bloodstream.
• Make hormones that help control blood pressure, create red blood cells and keep bones strong.

Cancer treatment

Often, a urologic surgeon does a nephrectomy to remove a cancerous tumor or an unusual growth in a kidney. The most common kidney cancer in adults, renal cell carcinoma, starts in the cells that line the small tubes within the kidneys.

Kidney tumors in children are rare. But children who get them are more likely to have a type of kidney cancer called Wilms tumor. Most often, this type of cancer is found in children under 5 years old.

The decision about how much kidney tissue to remove depends on:

• Whether a tumor is limited to the kidney or has spread outside it.
• Whether there is more than one tumor.
• How much of the kidney is affected.
• Whether the cancer affects nearby tissue.
• How well the other kidney works.
• Whether other diseases affect kidney function.
• Overall kidney function.

The urologic surgeon makes a decision based on the results of imaging tests. These may include:

• Computerized tomography (CT). A series of X-rays are used to create three-dimensional views of organs and tissues.
• Magnetic resonance imaging (MRI). A magnetic field and radio waves are used to make detailed pictures inside the body.
• Angiography. Special dye is injected into the body and X-rays are used to help find any blood vessels that might be fueling the tumor. Often, this test is done as part of an MRI or CT scan.
• Ultrasound. Sound waves are used to make an image of organs and tissues.

Treatment for other conditions

Nephrectomy may be needed to remove kidney tissue that is badly damaged, scarred, or not working due to a serious injury or other diseases.

Risks

Nephrectomy is often a safe procedure. But as with any surgery, it comes with risks such as:

• Bleeding.
• Infection.
• Injury to nearby organs.
• Pneumonia after surgery.
• Reactions to medicine that prevents pain during surgery, called anesthesia.
• Pneumonia after surgery.
• Rarely, other serious problems, such as kidney failure.

Some people have long-term problems from a nephrectomy. These complications relate to issues that can stem from having less than two fully working kidneys.

Problems that may happen over time due to less kidney function include:

• High blood pressure, also called hypertension.
• More protein in the urine than usual, a sign of kidney damage.
• Chronic kidney disease.

Still, a single health kidney can work as well as two kidneys. And if you're thinking of donating a kidney, know that most kidney donors live long, healthy lives after nephrectomy.

Risks and complications depend on the type of surgery, reasons for surgery, your overall health and many other issues. A surgeon's level of skill and experience are key as well.

Talk with your surgeon about the benefits and risks of nephrectomy to help decide if it's right for you.

How you prepare

Before surgery, you'll talk with your urologic surgeon about your treatment options. Questions you might ask include:

• Will I need a partial or complete nephrectomy?
• Can I get the type of surgery that involves smaller cuts, called laparoscopic surgery?
• What are the chances that I'll need a radical nephrectomy even if a partial nephrectomy is planned?
• If the surgery is to treat cancer, what other procedures or treatments might I need?

Planning your hospital stay

You may need to stay in the hospital from one night to a week or more. It depends on the type of nephrectomy you get. You can ask your surgeon and health care team how long it might take you to recover.

Preparing for the surgery

Your surgery team will likely give you instructions about what to do the day before and the day of your surgery. Write down any questions you might have, such as:

• How many hours before surgery do I need to stop eating, also called fasting?
• Can I take my prescription medicines?
• If so, how soon before the surgery can I take the medicine?
• What nonprescription medicines should I stay away from?
• When do I need to arrive at the hospital?

What you can expect

Before your nephrectomy starts, your care team gives you medicine that puts you in a sleep-like state and keeps you from feeling pain during surgery. This medicine is called general anesthesia. A small tube that drains urine from your bladder, called a catheter, also is placed before surgery. During the nephrectomy, the urologic surgeon and anesthesia team work together to minimize pain after surgery.

During the procedure

Nephrectomy varies based on how much of the kidney is removed and how the surgery is done.

The two main types of nephrectomy surgeries are:

• Radical nephrectomy. This is surgery to remove an entire kidney. Often, the urologic surgeon also takes out part of the tube that connects the kidney to the bladder, called the ureter. The gland that sits atop the kidney, called the adrenal gland, and some nearby lymph nodes also might be removed.
• Partial nephrectomy. This is surgery to remove part of a kidney. It's also called kidney-sparing or nephron-sparing surgery. The surgeon removes diseased or injured tissue from a kidney and leaves healthy tissue in place.

The ways that a nephrectomy can be done include:

• Open surgery. The surgeon makes a cut along the side or on the stomach area, also called the abdomen. This open approach is rarely needed. But it lets surgeons do some surgeries that still can't be done safely with less invasive approaches, such as laparoscopy.
• Laparoscopic surgery. The surgeon makes a few small cuts in the stomach area. A wand-like device tipped with a tiny video camera, called a laparoscope, is placed through the cuts to see inside the body. Then surgical tools remove the part or all of the kidney. Laparoscopic surgery often has benefits compared to open surgery. These include smaller cuts, shorter recovery time and hospital stays, and fewer complications after surgery.
• Robot-assisted laparoscopic surgery. The surgeon uses a robotic system to do the procedure. This method can help some surgeons move the tools with more ease and exactness compared to standard laparoscopic surgery. But if you're thinking about getting this type of surgery, the key is to find a surgeon who has lots of experience using a robotic system. In one review of studies, robot-assisted partial nephrectomy led to less blood loss, shorter hospital stays and fewer complications compared with open surgery.

Talk with your surgeon about the pros and cons of each type of surgery. Ask about issues such as scarring and the time it takes to return to your regular activities.

After the procedure

Your recovery time and the length of your hospital stay depend on your overall health and the type of nephrectomy performed. The catheter tube to drain urine from your bladder stays in place for a short time after surgery.

Before you leave the hospital, expect to get instructions about limits on your diet and activities. Your surgery care team may encourage you to start doing light, everyday activities as soon as you feel able. But you'll need to stay away from strenuous activity or heavy lifting for about six weeks or more as advised by your surgeon.

For most people, nephrectomy doesn't affect quality of life. Once you're fully recovered, you can expect to get back to your regular routine and activities.

Results

Questions that you may want to ask your surgeon or health care team after your nephrectomy include:

• How did the surgery go overall?
• What did the lab results show about the tissue that was removed?
• How much of the kidney is still intact?
• How often will I need tests to track my kidney health and the disease that led to the surgery?

Monitoring kidney function

Most people can do well with only one kidney, or with one whole kidney and part of the second. You'll likely have checkups to track the following factors, which are tied to how well the kidneys work:

• Blood pressure. If a kidney doesn't work as well as it used to, that can raise blood pressure — and high blood pressure can, in turn, damage the kidney.
• Protein urine levels. High protein urine levels, called proteinuria, may be a sign of kidney damage and poor kidney function.
• Waste filtering. A blood test called glomerular filtration rate checks how well the kidney filters waste from blood. A lower filtration rate is a sign the kidney has lost some function.

Taking care of your remaining kidney

If you have one healthy kidney after a nephrectomy, you can make simple changes to help take care of it:

• Stay away from contact sports, such as hockey, football, martial arts and soccer. These activities raise the risk of hits to the body that could damage the kidney. If you choose to play any of these sports despite the risk, wear extra padding and be careful.
• Eat a balanced diet. Try not to take in too much food that's high in sodium or salt. And drink plenty of water to stay hydrated. You can ask your doctor or a dietitian to help you come up with a meal plan.
• Stay at a healthy weight. Make smart food choices and get regular exercise to lose any extra pounds.

Your doctor may recommend other lifestyle changes if your kidney works less well over time after a complete or partial nephrectomy. You might be told to change your diet and to be careful about taking certain medicines.