Sarah Lewis, PharmD
What is a nephrectomy?
A nephrectomy is the surgical removal of a diseased or damaged kidney. A nephrectomy is a treatment for various kidney problems, including kidney cancer and irreversible kidney damage.
Your two kidneys are located on either side of your spinal column just below your ribcage. Your kidneys filter wastes and extra fluids from your blood, make urine, maintain electrolyte balance, help control blood pressure, and make certain hormones and enzymes.
A nephrectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a nephrectomy.
Types of nephrectomy
The types of nephrectomy include:
Bilateral nephrectomy is the removal of both kidneys. People with bilateral nephrectomies require dialysis or a kidney transplant to live.
Donor nephrectomy is the removal of a healthy kidney from a living donor for the purpose of transplantation.
Partial nephrectomy is the removal of only a portion of a diseased or damaged kidney.
Simple nephrectomy is the removal of an entire kidney.
Radical nephrectomy is the removal of an entire kidney, along with the adrenal gland (gland that sits on top of the kidney), surrounding lymph nodes, and possibly a section of ureter (tube that carries urine from the kidney to the bladder).
Other procedures that may be performed
Doctors sometimes perform a kidney transplant with a nephrectomy. A kidney transplant involves placing a donor kidney in the body to take over the work of severely damaged or diseased kidneys.
Why is a nephrectomy performed?
Your doctor may recommend a nephrectomy to treat certain diseases and conditions of the kidneys. Your doctor may only consider a nephrectomy for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a nephrectomy.
Your doctor may recommend a nephrectomy to treat:
End-stage kidney failure or irreversible damage from infections, stones, or other kidney diseases
Tumors including both cancerous and non-cancerous tumors and growths
Uncontrollable high blood pressure due to kidney problems
Who performs a nephrectomy?
The following specialists perform a nephrectomy:
Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.
Pediatric urologists specialize in diseases and conditions of the urinary tract and male reproductive organs in infants, children and adolescents.
Transplant surgeons specialize in transplant surgery of the kidney, liver, pancreas, and other organs.
How is a nephrectomy performed?
Your nephrectomy will be performed in a hospital. Your doctor will perform your nephrectomy using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an endoscope through small incisions in your abdomen. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Minimally invasive surgery may also include the use of a surgical robot or special imaging technologies (computer-assisted surgery) to help your surgeon view the area and perform the surgery.
Open surgery involves making an eight to 12 inch incision in your abdomen or side flank area. Open surgery incision allows your surgeon to directly view and access the surgical area. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform a nephrectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your nephrectomy
The day of your surgery, you can expect:
To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
To talk with the anesthesiologist or certified registered nurse anesthetist (CRNA) about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or CRNA will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a nephrectomy?
As with all surgeries, a nephrectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of a nephrectomy
Complications of a nephrectomy include:
Chronic decreased kidney function in the remaining kidney that can lead to high blood pressure and chr