Nephrectomy (Kidney Removal)

Nephrectomy (nuh-FREK-tuh-me) is a surgical procedure to remove all or part of a kidney:

• Radical (complete) nephrectomy. During a radical nephrectomy, the urologic surgeon removes the entire kidney and often some additional structures, such as part of the tube that connects the kidney to the bladder (ureter), or other adjacent structures such as the adrenal gland or lymph nodes.
• Partial nephrectomy. In a partial nephrectomy, also called kidney-sparing (nephron-sparing) surgery, the surgeon removes diseased tissue from a kidney and leaves healthy tissue in place.

Most often a nephrectomy is performed to treat kidney cancer or to remove a noncancerous (benign) tumor. In some cases, a nephrectomy is performed to deal with a diseased or seriously damaged kidney. In the case of a donor nephrectomy, the urologic surgeon removes a healthy kidney from a donor for transplant into a person who needs a functioning kidney.

The urologic surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen using a camera and small instruments (laparoscopic nephrectomy).

In some cases, these laparoscopic procedures are performed using a robotic system. In robotic surgery, the surgeon sits at a computer console near the operating table. He or she controls the camera arm and mechanical arms, which have surgical instruments attached to them that are working inside the patient's body.

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.

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

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.