Nephrectomy

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What is a nephrectomy?

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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:

  • Birth defects

  • End-stage kidney failure or irreversible damage from infections, stones, or other kidney diseases

  • Kidney donation

  • Trauma

  • 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.

How do I prepare for my 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

  • Blood clot

  • Infection 

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 chronic kidney disease

  • Damage to your urinary tract and other organs or structures in your abdomen

  • Herniation of the surgical wound

  • Kidney failure in your remaining kidney

Reducing your risk of complications


You can reduce the risk of certain complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Informing your doctor if you are nursing or if there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns such as bleeding, fever, increase in pain, change in urination, or wound redness, swelling or drainage
     
  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a nephrectomy by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, other imaging studies, a fine-needle biopsy, kidney function tests, urinalysis, blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a nephrectomy? Are there any other options for treating my condition?

  • Which type of nephrectomy procedure will I need?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How do I take my usual medications?

  • How will the nephrectomy affect urination?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

How do I prepare for my nephrectomy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for a nephrectomy by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, other imaging studies, a fine-needle biopsy, kidney function tests, urinalysis, blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a nephrectomy? Are there any other options for treating my condition?

  • Which type of nephrectomy procedure will I need?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How do I take my usual medications?

  • How will the nephrectomy affect urination?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours

What can I expect after my nephrectomy?

Knowing what to expect can help make your road to recovery after a nephrectomy as smooth as possible. 

How long will it take to recover?

You care team will move you after surgery to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care. 

It may take a few hours until the major effects of anesthesia wear off and you are alert. You may have a breathing tube in your mouth and tubes and wires attached to your body when you wake up. These devices allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids. 

You will not be able to talk with a breathing tube, but it is usually removed within 24 to 48 hours. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable.

You will move to a hospital room outside the ICU as you recover. This room will have equipment to monitor your vital signs. Hospital stays after a nephrectomy range from two to seven days.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes four to six weeks. 

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your nephrectomy. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after a nephrectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Bloody urine or other changes in urination that your doctor identifies as problematic

  • Change in alertness such as passing out, dizziness, unresponsiveness, or confusion

  • Chest pain or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate, pas gas, or have a bowel movement

  • Nausea, vomiting, or abdominal cramps

  • Pain or swelling in your legs

  • Pain that is not controlled by your pain medication

  • Unexpected drainage, pus, redness or swelling of your incision

How might a nephrectomy affect my everyday life?

A nephrectomy may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. It may also cause changes to your body that affect everyday life including the need to:

  • Avoid strenuous activity for a few weeks after your surgery

  • Avoid high contact or high risk sports due to the risk of damaging the remaining kidney

  • See your doctor on a regular basis to monitor your kidney function through urinalysis, blood pressure checks, and kidney function tests

  • Undergo dialysis or a kidney transplant if both kidneys are removed

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 2
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Nephrectomy. Cleveland Clinic. http://my.clevelandclinic.org/services/nephrectomy/urology_overview.aspx.
  2. Nephrectomy. National Kidney Foundation. http://www.kidney.org/atoz/content/nephrectomy.cfm.
  3. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.
  4. Radical Nephrectomy. UCLA Health System. http://urology.ucla.edu/body.cfm?id=555#WhatIsARadicalNephrectomy.
  5. Solitary Kidney. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/.
  6. Understanding the Various Surgical Approaches to the Most Common Form of Kidney Cancer. Kidney Cancer Association. http://www.kidneycancer.org/index.php/surgical-treatment