Nephrectomy (kidney removal)

What is Nephrectomy (kidney removal)?

A nephrectomy is a major surgery to remove all or part of your kidney. The kidneys are two small, bean-shaped organs in the abdomen. They filter water and waste products from your blood. They also produce certain hormones.

A nephrectomy is done when:

. Your kidney is damaged

. Your kidney is no longer functioning properly

. You have kidney cancer

. You’re donating your kidney

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Before Nephrectomy (kidney removal)

Kidney function

Most people have two kidneys — fist-sized organs located near the back of the upper abdomen. Your kidneys:

. Filter wastes and excess fluid and electrolytes from your blood

. Produce urine

. Maintain proper levels of minerals in your bloodstream

. Produce hormones that help regulate your blood pressure and that influence the number of circulating red blood cells.

Why it's done

The most common reason a urologic surgeon performs a nephrectomy is to remove a tumor from the kidney. These tumors are usually cancerous, but they can be noncancerous (benign). Sometimes a nephrectomy is needed because of other kidney diseases.

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. Cancer treatment

Often a urologic surgeon performs nephrectomy to remove a cancerous tumor or abnormal tissue growth in a kidney. The most common kidney cancer in adults, renal cell carcinoma, begins in the cells that line the small tubes within your kidneys.

Kidney tumors in children are rare. But when they occur, children are more likely to develop a type of kidney cancer called Wilms' tumor, probably caused by the poor development of kidney cells.

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

. Whether a tumor is confined to the kidney

. 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 functions

. Whether other diseases affect kidney function

. Overall kidney function

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

. Computerized tomography (CT), a specialized X-ray technology that produces images of thin cross-sectional views of soft tissues

. Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to produce cross-sectional views or 3-D images

. Ultrasound, an image of soft tissues produced with the use of sound waves.

. Treatment for other conditions

A partial or radical nephrectomy may be needed to remove severely damaged, scarred or nonfunctioning kidney tissue due to traumatic injury or other diseases.

. Donating a kidney

Sometimes, a person will donate their healthy kidney to someone who needs a new kidney. Kidney transplants are more successful with kidneys from living donors than deceased donors. You can be healthy with only one kidney.

Risks and Complications

Nephrectomy is generally a safe procedure. But as with any surgery, nephrectomy carries a potential risk of complications, such as:

. Bleeding

. Infection

. Injury to nearby organs

. Allergic reaction to anesthesia or other medications

. The formation of a blood clot in your legs that moves into your lungs, which is called a pulmonary embolism.

. Breathing difficulties

. A hernia in which organs might bulge out of your surgical incision

. Rarely, other serious problems such as heart attack and stroke.

Long-term complications from a nephrectomy relate to potential problems of living with less than two complete, fully functioning kidneys. Although overall kidney function decreases after a nephrectomy, the remaining kidney tissue usually works well enough for a healthy life.

Problems that may occur with long-term reduced kidney function include:

. High blood pressure (hypertension)

. Chronic kidney disease

Potential risks and complications depend on the type of surgery, reasons for surgery, patient's overall health and many other issues, including surgical expertise and experience.

For a better understanding of potential risks it's important that you discuss these issues with your urologic surgeon.

How you prepare

Before surgery, you'll talk with your urologic surgeon about what options are available for you. Questions you might ask include:

. Will I need a partial or complete nephrectomy?

. Am I a candidate for a minimally invasive procedure (laparoscopic, robotic or other)?

. What are the chances that I'll need a complete nephrectomy even if a partial nephrectomy is planned?

. If the surgery is for treating cancer, what other related 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, depending on the type of procedure. Ask your surgeon and health care team about your probable recovery time.

Preparing for the surgery

How do I prepare for kidney removal?

Be sure to tell your doctor and surgeon if you might be pregnant. Also, inform them about all medications you’re taking, including those that are over the counter. You may need to stop taking certain medications before the surgery, especially blood thinners.

Several days before the surgery, your doctor will draw blood. This will determine your blood type in case you need a transfusion during the procedure.

You will also need to fast and stop drinking liquids for a period before surgery.

You'll receive instructions about what to do the day before and the day of your surgery. Make note of any questions you might have, such as:

. When do I need to begin fasting?

. Can I take my prescription medications?

. If so, how soon before the surgery can I take a dose?

. What nonprescription medications should I avoid?

. When do I need to arrive at the hospital?

During Nephrectomy (kidney removal)

What you can expect

A nephrectomy procedure is performed during general anesthesia. You'll receive a medication (anesthetic) before surgery so that you won't be awake or feel pain during surgery. You'll also have a urinary catheter — a small tube that drains urine from your bladder — placed before surgery. During the procedure, the urologic surgeon and anesthesia team work together to minimize pain after surgery.

During the procedure

The nephrectomy procedure varies, depending on how the surgery is performed and how much of the kidney is removed. Variations include:

. Laparoscopic surgery. In this minimally invasive procedure, the surgeon makes a few small incisions in your abdomen to insert wand like devices equipped with video cameras and small surgical tools. The surgeon must make a slightly larger opening if your entire kidney needs to be removed.

. Robot-assisted laparoscopic surgery. In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon's hand can do in open surgery.

. Open surgery. In an open nephrectomy, the urologic surgeon makes a cut (incision) along your side or on your abdomen. This open approach allows surgeons to perform some surgeries that still can't be performed safely with less invasive approaches.

. Radical nephrectomy. In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland. In some cases lymph nodes or other tissues are removed as well.

. Partial nephrectomy. In a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible.

Your urologic surgeon will discuss the advantages and disadvantages of robotic or other types of minimally invasive surgery versus open surgery, including issues such as scarring and the time it takes to return to normal activities.

After Nephrectomy (kidney removal)

After the procedure

Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of nephrectomy performed. The urinary catheter remains in place for a short time during your recovery.

Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you'll need to avoid strenuous activity or heavy lifting for several weeks.

For most patients, these procedures don't affect quality of life — once you're completely recovered, you can expect to resume your normal routine and activities.

Results

Questions that you may want to discuss with your urologic surgeon or other members of your health care team after your nephrectomy include:

. How did the surgery go overall?

. What did you learn from pathology about the tissue that was removed?

. How much of the kidney was preserved?

. How often will I need additional testing to monitor my kidney function and the disease that prompted the surgery?

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Monitoring kidney function

Most people can function well with only one kidney or with one whole kidney and part of the second. You'll likely have checkups to monitor the following factors related to kidney function.

. Blood pressure. You'll need careful monitoring of your blood pressure because decreased kidney function can increase blood pressure — and high blood pressure can, in turn, damage your kidney.

. Protein urine levels. High protein urine levels (proteinuria) may indicate kidney damage and poor kidney function.

. Waste filtration. Glomerular filtration rate is a measure of how efficiently your kidney filters waste. The test is usually performed with a sample of blood to measure the creatinine level. A reduced filtration rate indicates decreased kidney function.

Taking care of your remaining kidney

After a nephrectomy or partial nephrectomy, you may have overall normal kidney function. To preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity and attend regular checkups to monitor your kidney health.

If you develop chronic kidney disease (reduced kidney function) after complete or partial nephrectomy, your doctor may recommend additional lifestyle changes, including possible dietary changes and being careful about prescription and over-the-counter medications.

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