Nephrectomy

A surgical procedure to remove a part or all of the kidneys is called nephrectomy or kidney removal. The surgeon will remove the entire kidney or radical nephrectomy while in partial nephrectomy he will just remove the diseased tissue from a kidney and leaves the healthy tissues. This is performed to remove a seriously diseased or damaged kidney or to treat kidney cancer.

The surgeon removes a healthy kidney for transplant into a person who needs a functioning kidney in a donor nephrectomy. He might perform this through a series of small incisions in the abdomen (laparoscopic nephrectomy) or through a single large incision in the abdomen or side (open nephrectomy).

Here are the most common reasons to undergo a nephrectomy (kidney removal).

A surgeon performs this to either harvest a healthy kidney intended for an organ transplant or to remove a diseased kidney.

The uses of your kidney include:

• Produce urine.
• Filter wastes and excess fluid and electrolytes from your blood.
• Produces hormones that help regulate your blood pressure which can lead to influencing the number of circulating red blood cells.
• Maintain proper levels of minerals in your bloodstream.

Sometimes this is done to remove a cancerous tumor or abnormal tissue growth in a kidney. Because of the poor development of kidney cells, children can develop Wilms’ tumor which is a type of kidney cancer.

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

• Whether there is more than one tumor.
• Whether a tumor is confined to the kidney.
• Whether cancer affects nearby tissue.
• How much of the kidney is affected.
• How well the other kidney functions.

The surgeon will make a decision based on the results of the imaging tests such as:

• CT scan which produces images of thin cross-sectional views of soft tissues.
• Ultrasound which projects images of soft tissues with the use of sound waves.
• MRI that uses a magnetic field and radio waves to produce cross-sectional views or 3-D images.

A partial or radical nephrectomy may be needed to remove severely damaged, scarred or nonfunctioning kidney tissue due to traumatic injury or other diseases. A good candidate for donating a kidney to someone who needs a transplant must be a healthy person with a low risk of certain disorders such as diabetes or high blood pressure and has a good kidney function.

Potential risks of living with less than two complete and fully functioning kidneys are related to long-term complications from a nephrectomy.

The problems that may occur if you have a long-term decreased kidney function include:

• Chronic kidney disease
• High blood pressure

You might want to talk to your surgeon in order to prepare for the nephrectomy (kidney removal).

You can ask your surgeon:

• Do I need partial or complete nephrectomy?
• Am I a candidate for laparoscopic procedure?
• What are the chances that I will need a complete nephrectomy even if a partial one is planned?
• Do I need other procedures or treatments?

Depending on what type or procedure you will undergo you might stay at the hospital for 1 to 5 five days.

Before the procedure, you can ask your surgeon:

• When do I need to begin my fasting?
• Can I still take my prescription drugs?
• What nonprescription should I avoid?
• When do I need to arrive at the hospital?

You will have certain exams and tests to make sure you are a suitable candidate if you are planning to donate a kidney for a transplant.

The criteria are:

• If you are 18 years old and above.
• General good health.
• Compatible blood type with kidney transplant recipient.
• Two-well functioning kidneys.
• Stable mental health.
• No history of high blood pressure, diabetes, kidney disease, cardiovascular disease or certain cancers.

Here’s what you can expect before, during, and after your nephrectomy (kidney removal).

Before the surgery, you will receive anesthesia so you cannot feel any pain or you will not be awake. Your doctor will put a urinary catheter to drain urine from your bladder.

The variations of the nephrectomy procedure include:

• Open surgery – to gain better access to the kidney, your surgeon will make a small incision along the side of your abdomen or may remove a lower rib.
• Laparoscopic surgery – this is minimally invasive procedure and your doctor will insert wand-like devices equipped with video cameras and small surgical tools by making a few small incisions in your abdomen.
• Radical nephrectomy – the surgeon will remove the fatty tissues surrounding the kidney and the whole kidney and the ureter, the adrenal gland that sits atop the kidney if a tumor is close may be removed also.
• Robot-assisted laparoscopic surgery – the surgeon may use a robotic system with robotic tools by making small incisions provide better imaging of the procedure and enable precise removal of diseased tissue.
• Partial nephrectomy – also known as kidney-sparring surgery, the surgeon will remove a diseased or cancerous tumor and leave the healthy ones.

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. Your doctor will give you restrictions about food and activities such as strenuous activities before you leave the hospital.

After the procedure, you and your oncologist will discuss the nephrectomy results.

You can ask questions such as:

• Were you able to remove all of the cancerous or diseased tissue?
• How much of the kidney was removed?
• Will I need extra treatments?
• How often should my kidney function be monitored?

Your doctor will advise follow-up visits to monitor your kidney and other factors such as:

• Protein urine levels because high protein urine levels or proteinuria may indicate poor kidney function and kidney damage.
• Blood pressure to check if it is increasing which can lead to kidney damage.
• Waste filtration or glomerular filtration rate is to measure how efficient your kidney in filtering waste.

Your doctor will suggest eating a healthy diet such as limiting salt or protein and doing physical activities and also have regular checkups to preserve normal kidney function.