Kidney Removal: Pre- and Post-Op Guidance

James Myhre & Dennis Sifris, MD
·12 min read

Types of Nephrectomy and What to Expect

Medically reviewed by David Hampton, MD

Kidney removal, or nephrectomy, is a type of surgery that removes part of a kidney (partial nephrectomy) or all of a kidney (simple or radical nephrectomy). There are different approaches to kidney removal surgery, including open and laparoscopic surgery.

A nephrectomy is a major surgery that may be performed if there is irreversible damage caused by an injury, a chronic infection, or diseases like polycystic kidney disease or kidney cancer.

This article describes the different types of kidney removal surgery, including how they are performed, possible complications, and what to expect during recovery.

<p>nattrass / Getty Images</p>

nattrass / Getty Images

Types of Kidney Removal Surgery

There are different types of kidney removal surgery and different ways to perform them. The choice of surgery varies by the condition it's treating.

Nephrectomy can be performed either with traditional open surgery (using a scalpel and large incision) or minimally invasive laparoscopic surgery (using smaller "keyhole" incisions, a narrow lighted scope, and pencil-like tools).

There are four types of nephrectomy characterized by how much tissue the surgery is removing:

Partial Nephrectomy

With a partial nephrectomy, only part of one kidney is removed. This may be used if a traumatic injury irreversibly damages part of a kidney or a benign (noncancerous) tumor needs to be removed.

Partial nephrectomy is also considered the gold standard for treating a type of cancer called renal cell carcinoma (RCC), in which the tumor is localized and has not spread. It can't be used for everyone but may be considered for early-stage RCC with a negative surgical margin (meaning there are no cancer cells found at the edge of the tissues surrounding the tumor).



What Is Renal Cell Carcinoma?

Renal cell carcinoma is the most common type of kidney cancer, accounting for around nine out of every 10 cases. It affects the tubes of the filters of the kidneys known as nephrons.

Although RCC usually occurs as a single tumor in one kidney, there can sometimes be two or more tumors in one kidney or tumors in both kidneys.



Related: What Are the Signs of Kidney Cancer?

Simple Nephrectomy

With a simple nephrectomy, all of one kidney is removed without any adjacent tissues. It is performed when there is irreversible damage to a kidney caused by a traumatic injury, an obstruction of the renal vein, a large kidney stone, or a chronic pyelonephritis (kidney infection).

Simple nephrectomy was once the standard for treating RCC but has since been replaced by the more expansive radical nephrectomy.

Radical Nephrectomy

Radical nephrectomy is the cornerstone treatment for RCC that has not metastasized (spread to distant organs). On rare occasions, it may be used for metastatic RCC if a person is in good health and it helps them live longer.

For this surgery, all of one kidney is removed along with its neighboring adrenal gland (which rests atop the kidney) and nearby lymph nodes. By removing these tissues, the odds of disease-free remission increase.

Bilateral Nephrectomy

Bilateral (two-sided) nephrectomy is when both kidneys are removed.  It is an extreme measure for when both kidneys are damaged to the point that they can no longer meet the body's needs.

Bilateral nephrectomy may be indicated when a person has:

Bilateral nephrectomy is considered a last resort when all other treatments fail. A person undergoing this procedure requires either a kidney transplant or treatments like continuous hemodialysis to stay alive.

Related: What to Know About Transplant Surgery

Kidney Removal Procedure: How They Are Performed

Kidney removal surgery is performed in a hospital by a urologic surgeon. General anesthesia is applied to make you fully unconscious.

Nephrectomy is a major surgery that can take three or more hours to complete. The approach can vary based on whether the surgery is open or laparoscopic.



Preoperative Procedures

Before having a nephrectomy, you will need to undergo a battery of tests to evaluate the condition of your kidneys and your risk of surgical complications. These may include:



After you have been cleared for surgery, the actual procedure may take different forms:

Open Simple Nephrectomy

Open simple nephrectomy is performed as follows:

  1. You lie on the operating table on your side.

  2. The surgeon makes an incision up to 12 inches long just below or right over the ribs.

  3. A rib and underlying tissues are removed to expose the kidneys.

  4. Blood vessels and the tube that carries urine from the kidney to the bladder (ureter) are cut.

  5. The affected kidney is retracted (removed) either completely or partially.

  6. The incision is closed with stitches or staples.

Open Radical Nephrectomy

Open radical nephrectomy is performed as follows:

  1. You lie on your back or your side on the operating table.

  2. The surgeon makes an incision up to 12 inches long on your belly just below the ribs. In some cases, the surgery is approached from the side.

  3. Blood vessels and the ureter are cut.

  4. The kidney is removed along with the adrenal gland and nearby lymph nodes.

  5. The incision is closed with stitches or staples.

Laparoscopic Nephrectomy

Laparoscopic nephrectomy is performed as follows:

  1. You lie on your side on the operating table.

  2. The surgeon makes three or four small incisions around 1 inch long on your belly and side.

  3. A narrow scope called a laparoscope is inserted into one of the incisions to view the surgery.

  4. Narrow tools are inserted into the other incisions to sever the ureter and blood vessels.

  5. One of the incisions is then widened to roughly 4 inches.

  6. A bag is placed around the kidney, which is then pulled out of the larger cut.

  7. The incisions are closed with stitches, staples, or adhesives.

Laparoscopic nephrectomy may take longer than an open kidney removal, but people tend to heal from it faster and with less pain.

Kidney Removal Recovery: What to Expect

As with all major surgeries, recovery from a nephrectomy can take time. After a nephrectomy, you will usually stay in the hospital for one to seven days, although recovery can take anywhere from six to 12 weeks.

During Hospitalization

Immediately after surgery, you will be asked to sit on the side of the bed and walk. Doing so promotes blood circulation and helps prevent blood clots. You may also have a tube (catheter) coming from your bladder that will later be removed. There may also be a surgical drain in your incision.

While in the hospital, you may not be permitted to eat for the first day or so but will gradually ease into a liquid diet before you can consume more solid food.

Compression socks may be provided to prevent clots in your legs and a potentially serious condition known as deep vein thrombosis (DVT). Deep breathing exercises may be recommended to reduce the risk of pneumonia (lung infection).

Pain Management

After a nephrectomy, you can expect pain for anywhere from one to two weeks. The pain can often be managed with over-the-counter drugs like Tylenol (acetaminophen) or 15-minute ice applications several times a day. Stronger medications, including opioids, may be prescribed if the pain is severe.

Do not take aspirin, Advil (ibuprofen), Aleve (naproxen), or any other nonsteroidal anti-inflammatory drug (NSAID) unless your surgeon gives you the OK. These drugs can promote bleeding and slow healing.

You will also need to avoid exercises or activities that place stress on the abdominal muscles. This includes heavy lifting (including the lifting of children and groceries) for at least four weeks.

Rest is important during your recovery. Even so, you should try to walk each day, walking a little more than you did the day before.

Incision Care

You may be able to shower when you return home unless you have a surgical drain. If you do, you may need to take a sponge bath until 48 hours after the drain is removed. You should not take an immersion bath for the first two weeks or until your surgeon tells you it's OK.

If you have surgical strips on your incision, do not peel them off. Leave them in place for a week or until they fall off.

Always keep the area around the incisions clean and dry to avoid infection. Wash the area daily with warm, soapy water and pat the skin dry. You can cover the wound afterward with a gauze bandage if there is any weeping, but be sure to change it daily. Do not clean the incision with alcohol or hydrogen peroxide, which can delay healing.

If you need to cough or sneeze, hold a pillow tightly over the incision to avoid exerting enough pressure on the wound to make it open, rupture, or bleed.

Weight Changes

Weight gain is not uncommon after nephrectomy. It may occur as a result of postoperative edema, in which fluids accumulate in tissues due to extreme inflammation. It may also result from intravenous (IV) fluids given during surgery. The fluid overload may be limited to the incision site or involve the entire body.

In situations like this, the edema tends to resolve on its own as you heal, though some people need diuretics ("water pills") to help ease the fluid overload.

You may also gain weight if you had a kidney transplant. Studies suggest that two out of three transplant recipients gain weight as their kidneys start to function normally again. When this happens, waste products like urate, which suppress appetite, no longer build up in the system.

On the other hand, weight loss after partial or radical nephrectomy for RCC is linked to an increased risk of cancer recurrence, often within 18 months.

Living With One Kidney: Life After Removal

If you have one kidney removed, there should be no ill effects as long as the other is working normally. In short, one healthy kidney can more than accommodate your body's needs.

Even so, there are things you will need to do to keep healthy:

  • See your healthcare provider regularly: A healthcare provider should check your blood pressure and kidney function at least once a year to ensure your kidney is working normally.

  • Avoid injuries: Exercise can keep your heart and kidneys healthy, but you should avoid contact sports like football, boxing, hockey, soccer, martial arts, or wrestling, which can injure the kidneys.

  • Eat a healthy diet: People with one healthy kidney don’t need a special diet. However, eating a well-balanced diet and cutting back on salt are always good ideas because too much salt can increase the risk of proteinuria (protein in urine), which contributes to kidney disease.

Related: What Happens if Your Kidneys Fail?

Kidney Removal Surgical Complications

As with any major surgery, nephrectomy can lead to complications. Some are general surgical complications like postoperative infection, pneumonia, and reactions to anesthesia. Others may be associated with the nephrectomy procedure.

Possible complications of kidney removal surgery include:

The risks tend to be greater with radical nephrectomy than with partial nephrectomy. Even so, the risk of reoperation is greater with partial nephrectomy.

These factors must be assessed to determine which type of surgery is most appropriate for people with RCC. This is especially true given that there is no evidence that partial nephrectomy is any less effective than radical nephrectomy in extending the lives of people with early-stage RCC.

Related: Most Common Complications of Surgery

Pathology Results From Kidney Removal

If a simple or partial nephrectomy is performed, the kidney or retracted tissues are taken to a lab for evaluation. The medical pathologist is tasked with performing gross (visual) and histological (microscopic) examinations to determine if there are any pathologic (disease-related) findings.

Chief among these is the detection of cancer. If no cancer is found, it is considered a benign pathologic finding.

If a person is known to have cancer, the evaluation of the kidney, adrenal gland, and lymph nodes can inform the cancer stage and grade as well as the appropriate course of treatment.

By definition:

  • Cancer staging determines how advanced a cancer is based on its size and how much it has spread to nearby lymph nodes or distant organs.

  • Cancer grading describes how aggressive a cancer is based on how normally or abnormally the cancer cells look under the microscope.

These findings are issued on a pathology report, which your surgeon can share and explain to you.

Related: How Kidney Cancer Is Diagnosed

Ongoing Care and Management

If you have a kidney removed, you may experience increased high blood pressure (hypertension). This is because the flow of blood between the kidneys and heart influences your blood pressure, and the loss of one kidney intensifies the pressure between the two. This places stress on the remaining kidney, leading to a possible loss of kidney function over time.



Hypertension After Nephrectomy

Studies suggest that one in four people who undergo nephrectomy will experience new-onset hypertension irrespective of the type of surgery they had.



To reduce the burden on your kidney, your healthcare provider may recommend the following interventions if you experience new-onset hypertension after kidney removal:

Despite these concerns, most people only experience a mild loss of kidney function after a nephrectomy. In the absence of cancer, a person with one kidney can go on to live a normal, healthy life.

Summary

Nephrectomy is the surgical removal of part or all of a kidney. It may be performed as an open or laparoscopic surgery to treat conditions ranging from kidney trauma and renal vein hypertension to kidney cancer and end-stage renal disease.

Nephrectomy is a major surgery performed under general anesthesia. Recovery can take anywhere from six to 12 weeks. If both kidneys are removed, a kidney transplant or hemodialysis is necessary to keep the person alive.

Read Next: How Kidney Cancer Is Treated

Read the original article on Verywell Health.