Nephrectomy

What is a nephrectomy?

A nephrectomy is the surgical removal of part or all of one kidney. Most people have two kidneys at birth. But you can live with only one, as long as it’s healthy and functioning well.

There are two types of nephrectomy procedures:

• Partial nephrectomy. During a partial nephrectomy, a surgeon removes only the diseased or damaged portion of your kidney.
• Radical nephrectomy. During a radical nephrectomy, a surgeon removes the entire kidney. They may also perform a nephrourectomy. A nephrourectomy removes your entire ureter on that same side, which is the tube that carries urine (pee) from your kidney to your urinary bladder. In some cases, the surgeon may also remove the adrenal gland on your kidney, and the lymph nodes around it.

What is the most common reason for a nephrectomy?

The most common reason to have a nephrectomy is to remove a kidney tumor. A kidney tumor may be cancerous (malignant) or noncancerous (benign).

A healthcare provider may also recommend a nephrectomy if:

• You get recurrent (repeat) kidney infections (pyelonephritis)
• Your kidney stopped working and it’s causing you problems (if it isn’t causing problems, you can keep a nonfunctional kidney)
• You need treatment for other kidney diseases (for example, polycystic kidney disease) or injuries
• You’re donating a healthy kidney

How common are nephrectomies?

Nephrectomies are a common procedure. Each year, surgeons perform tens of thousands of nephrectomies in the United States.

How should I prepare for this procedure?

Before a nephrectomy, a healthcare provider will conduct a physical examination to check your general health, including your temperature, pulse and blood pressure. They may also conduct a blood test to determine your blood type. They’ll need to know your blood type in case you need a blood transfusion during surgery.

Tell the provider about any ongoing medical concerns so they can help you plan for a nephrectomy. This will include any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol®), blood thinners (anticoagulants) and certain herbal supplements can increase your risk of bleeding.

It’s also a good idea to tell your provider about any allergies you have. These include allergic reactions to:

• Medications
• Skin cleaners, like chlorhexidine, iodine or isopropyl alcohol
• Latex
• Foods

The provider will likely instruct you to fast (not eat) and stop drinking fluids the night before the nephrectomy. Food or fluids in your stomach during surgery can increase your risk of vomiting. If you inhale (aspirate) into your lungs, it can affect your breathing and cause pneumonia and other potentially deadly complications.

They’ll verify which kidney they’ll remove and discuss which nephrectomy approach is best for you.

What are the different types of nephrectomy approaches?

There are two surgical approaches to a nephrectomy:

• Open nephrectomy
• Laparoscopic/robotic-assisted nephrectomy

Open nephrectomy

During an open nephrectomy, the surgeon uses a sharp knife (scalpel) to make a cut (incision) in your side or abdomen. The incision may be as long as 12 inches (30 centimeters). The surgeon looks directly inside your body and doesn’t use a camera. A surgeon may recommend an open nephrectomy if you have a large kidney tumor or a partial nephrectomy if they can remove the tumor without risk to the remainder of your kidney.

Laparoscopic/robotic-assisted nephrectomy

This is a less invasive approach. During a laparoscopic surgery, the surgeon uses a laparoscope to perform the surgery. A laparoscope is a thin, metal tool with a camera at the end. A laparoscopic nephrectomy uses several small incisions (less than an inch, typically 0.5 cm to 1 cm) instead of a large incision. Typically, the surgeon will increase one incision in size to extract the kidney or kidney tumor. A robotic-assisted laparoscopic nephrectomy uses a surgical robot. The surgeon controls the robot to manipulate the small tools in areas that are difficult to reach.

What happens during a nephrectomy?

The group of healthcare providers that make up your care team during a nephrectomy generally includes:

• A urologist
• An anesthesiologist
• Nurses

The anesthesiologist will sedate you with general anesthesia. You’ll be asleep, won’t move and won’t feel any pain during the procedure. After you’re asleep, a nurse or physician will insert a urinary catheter to drain any pee from your bladder.

During a radical or partial laparoscopic nephrectomy, the urologist will:

• Use a scalpel to make one or several small incisions in your abdomen or side (flank)
• Insert a laparoscope through an incision
• View the camera image from the laparoscope on a large screen
• Insert a small tube into an incision to fill your abdominal cavity with carbon dioxide gas (insufflation) — the gas separates the abdominal wall from your organs so it’s easier to see and move the surgical instruments
• Insert a few additional tubes (ports) that allow the urologist to easily switch instruments, such as graspers or scissors
• Move your bowel away from the kidney and identify blood vessels that transport blood into and out of the kidney
• Either permanently close and cut those blood vessels (for a radical nephrectomy) or temporarily place clamps to block blood flow (partial nephrectomy)
• Use small surgical tools to remove the diseased portion of your kidney or your entire kidney
• If necessary, remove any affected lymph nodes, the adrenal gland and part of the ureter
• Release the carbon dioxide gas from your abdomen (some gas will remain behind)
• Possibly insert a surgical drain into the incision to help drain excess fluids as you heal
• Close the incision(s) with small stitches (sutures) that will later dissolve on their own after your incision heals, surgical staples or both

During a radical or partial open nephrectomy, the urologist will:

• Use a scalpel to make an incision in your abdomen or flank
• Examine your kidney and the surrounding area to make sure damage hasn’t spread
• Either permanently close and cut those blood vessels for a radical nephrectomy or temporarily place clamps to block blood flow for a partial nephrectomy
• Use small surgical tools to remove the diseased portion of your kidney or your entire kidney
• Insert a surgical drain to prevent fluid buildup and help with healing
• Close the incision with sutures, staples or both

How long does a nephrectomy take?

On average, a nephrectomy can take two to four hours to complete. But it can take longer according to your anatomy. Your surgeon will give you a better idea of what to expect.

What happens after a nephrectomy?

Immediately after a nephrectomy, the care team will:

• Cover your affected areas with a surgical glue or bandage
• Stop putting anesthesia into your body (you’ll wake up in a few minutes, but you’ll probably still feel groggy and nauseated)
• Send the kidney, tumor or both to a laboratory for testing (pathology)
• Move you to a recovery room, where they’ll wait for you to wake up more fully and track your overall health
• Treat your pain and teach you pain management techniques

Your healthcare team will monitor your blood pressure, blood chemistry, electrolytes and fluid levels. You may need to avoid solid foods for a day or two after surgery. Liquids help give your body time to recover.

Usually, within a day after surgery, providers will encourage you to walk. Walking helps the healing process by promoting blood flow to the area. Walking can also help reduce your risk of developing other complications, including blood clots in your legs (deep vein thrombosis).

Because an incision will be near your diaphragm, breathing deeply may be uncomfortable. Providers will teach you diaphragmatic breathing exercises. These exercises, laying with your upper body propped up and walking are important for preventing pneumonia.

Typically, the day after surgery, a provider will remove the urinary catheter.

How long do I have to stay in the hospital after a nephrectomy?

After a nephrectomy, you’ll stay in the hospital for one to five days. Your hospital stay depends on what type of nephrectomy you have and other factors.

Once your care team determines you’re well enough, they’ll let you go home. You may still have pain or difficulty moving, so a family member or friend must drive you home. It’s a good idea to have a friend or family member help take care of you for at least a few days after the procedure, too.

Is a nephrectomy a major surgery?

Yes, a nephrectomy is a major surgery. It’s an inpatient procedure, which means most people stay in the hospital for at least one or more days for observation and rehabilitation as they recover.

Do I need both kidneys?

Most people have two kidneys at birth. But you can function and lead a fulfilling life with only one functional kidney.

If a healthcare provider removes both of your kidneys, you’ll need a kidney transplant or dialysis to remain alive.

What happens to the remaining kidney after a nephrectomy?

After a nephrectomy, your remaining kidney increases in size and does more work within a few days to increase its ability to filter your blood and remove waste.

A healthcare provider will conduct kidney function tests about six weeks after the procedure to monitor the health and function of your remaining kidney. The provider will give you instructions on how often you need these tests.

What are the benefits of a nephrectomy?

The main benefit of a nephrectomy is that it can treat conditions that affect your kidney. In cases of kidney cancer, a nephrectomy can be a lifesaving procedure.

If you have a nephrectomy to donate a kidney, your donor kidney can save a loved one’s life.

What are the risks or complications of a nephrectomy?

All surgeries carry some risks, including a nephrectomy. Some general risks include:

• Pain
• Bleeding
• Infection
• Sepsis
• Anesthesia complications
• Post-operative pneumonia
• Blood clots
• Scarring
• Kidney (renal) injury or renal failure

If you have or develop kidney disease or damage in your remaining kidney, you also have a small risk of kidney failure.

How painful is kidney removal surgery?

You’ll have some discomfort and pain after kidney removal surgery. Many people manage their pain with prescription and over-the-counter pain medications. The first several days after surgery are often the most painful. A healthcare provider can give you a better idea of what to expect and offer treatment and pain management options.

What is the recovery time after a nephrectomy?

Your recovery depends on the type of nephrectomy you have. An open nephrectomy has a longer recovery time than a laparoscopic nephrectomy.

Shortly after surgery, healthcare providers will encourage you to get out of bed and walk. Walking helps:

• Your body recover
• Limit your risk of developing blood clots
• Prevent pneumonia

When you return home, you may be able to return to light activity after a week or two. You should avoid heavy lifting (anything heavier than 10 pounds or 4.5 kilograms) or strenuous activity for at least six weeks. A healthcare provider will give you a better idea of your recovery timeline.

What foods should I avoid after having a kidney removed?

You may work with a healthcare provider who specializes in kidney diseases (renal dietitian) to create eating patterns that promote kidney health. Cutting back on sodium (salt), saturated fat and cholesterol helps reduce stress on your kidney. You should also drink lots of water — about six to eight glasses a day.

When can I go back to work or school after a nephrectomy?

You should be able to return to work or school within a few weeks after a nephrectomy. You may need to take even more time off if you have a physically demanding job.

What is life like after having a kidney removed?

For many people, having a nephrectomy doesn’t prevent them from returning to their regular activities. If you have one healthy kidney, it can typically perform every task your body needs it to. However, you should stay away from activities that increase your risk of kidney injury. This may include high-contact sports, such as hockey, wrestling, rugby, lacrosse or football.

You may need to make adjustments to your eating patterns, physical activity and see a healthcare provider regularly for check-ups.

If you have a nephrectomy in childhood, it’s possible your remaining kidney will lose some function later in life. This usually happens at least 25 years later. But any kidney function loss is typically mild.

What is the life expectancy after kidney removal?

Your life expectancy depends on your overall health and any other health conditions you have. A healthcare provider can give you a better idea of what to expect according to your health history.

When should I call a healthcare provider?

Your healthcare provider will schedule regular follow-up appointments to examine your stitches and monitor your recovery. If you have a drainage tube, they’ll usually remove it after a few days.

If you had a nephrectomy to treat kidney cancer, you’ll need regular tests to make sure the kidney cancer doesn’t return. Most people get CT scans, MRIs or other imaging tests every three to 12 months for up to 10 years after surgery. Typically, the further out from surgery, the fewer imaging tests you’ll need. You may also need regular urine tests (urinalyses) and blood pressure checks.

If you have protein (proteinuria), calcium (hypercalciuria) or blood (hematuria) in your pee, there may be a problem with your remaining kidney. Every few years, you’ll need to test your kidney functions, as well, including a creatinine clearance test and estimated glomerular filtration rate (eGFR).

You should call 911 or contact a provider right away if you have any signs of kidney failure or sepsis. Call a provider if you notice:

• Difficulty breathing or shortness of breath (dyspnea)
• Changes in your pee, including peeing more often than usual (frequent urination) or changes in the color
• Swelling (edema) in your legs, lower back or face
• Pain in your legs
• Increasingly high blood pressure (hypertension)
• Nausea or vomiting
• Brain fog

What is a bilateral nephrectomy?

A bilateral nephrectomy is the surgical removal of both kidneys.

Can you live without both kidneys?

Yes, you can live without both kidneys with regular dialysis or a kidney transplant. Dialysis performs the function of your kidneys by filtering toxins and excess water from your blood.