Nephrectomy

What this procedure is

A nephrectomy is a surgical procedure to remove all or part of a kidney. The kidneys are two bean-shaped organs located near the back of the upper abdomen. Their main job is to filter waste and extra fluid from the blood to create urine.

There are two primary types of this surgery:

• Partial nephrectomy: The surgeon removes only the diseased or injured part of the kidney and saves the healthy tissue.
• Radical nephrectomy: The surgeon removes the entire kidney.

Your clinician may perform the surgery through one large opening, known as open surgery. Alternatively, they may use several small incisions, called laparoscopic surgery, which uses a tiny camera and specialized tools to see inside the body.

What it treats or fixes

The most common reason for a nephrectomy is to treat kidney cancer or to remove a tumor that is not cancerous. By removing the growth, surgeons aim to prevent the spread of disease and protect the rest of the body.

This surgery may also be used to treat a kidney that is severely damaged or no longer functioning. This damage can be caused by several factors, including:

• Chronic infections or long-term inflammation.
• Severe scarring caused by kidney stones.
• Birth defects or other conditions that prevent the kidney from working correctly.

Additionally, a nephrectomy is performed on healthy individuals who choose to donate a kidney to a person in need of a transplant.

How common it is & where it's done

Nephrectomy is a standard medical procedure performed frequently in hospitals. It is typically done by a urologist, which is a doctor who specializes in the urinary tract and the kidneys.

Most people can live a healthy, active life with just one functioning kidney. If both kidneys are removed or are not working well, your clinician may discuss other ways to filter your blood, such as dialysis.

The surgery is performed in a hospital setting under general anesthesia. This means you will be in a deep sleep and will not feel any pain during the procedure. Your care team will monitor you closely before, during, and after the surgery to ensure your safety.

Recovery: What to Expect

After a nephrectomy (surgery to remove all or part of a kidney), you will likely stay in the hospital for one to seven days. Your care team will help you manage any discomfort with medicine. They will also encourage you to get out of bed and walk as soon as you are able, which helps prevent blood clots and aids the healing process.

Once you go home, your clinician may suggest avoiding heavy lifting or intense exercise for several weeks. You will gradually return to your normal routine. It is common to feel tired for a while as your body focuses its energy on healing.

Risks & Possible Complications

Every surgery has some risks. While complications are not common, they can include things like bleeding, infection, or blood clots in the legs. In some cases, there may be a small risk of injury to nearby organs or a temporary change in how well the remaining kidney works.

Your care team will monitor you closely during your stay. After you go home, you should contact your clinician if you notice any of the following:

• A fever or chills.
• Redness, swelling, or fluid leaking from the surgical site.
• Pain that gets worse instead of better.
• Shortness of breath or a new cough.

Outcomes & Long-Term Results

Most people who have one kidney removed go on to live a full and healthy life. The remaining kidney usually grows slightly larger to take over the work of both. Your clinician may schedule regular follow-up visits to check your blood pressure and kidney function through simple blood and urine tests.

To keep your remaining kidney healthy, your clinician may recommend a balanced diet, staying hydrated, and staying active. It is also important to talk to your doctor before taking certain over-the-counter pain relievers, as some medications can be hard on the kidneys over time.

Emotional Support & Reassurance

It is natural to feel a bit nervous about living with one kidney or recovering from a major procedure. Remember that the human body is very strong and capable of adapting. Many people live active, long lives with just one kidney without any major changes to their lifestyle.

If you feel overwhelmed, your healthcare team is there to support you. Sharing your feelings with family, friends, or a support group can also help you feel more confident as you recover and return to your daily activities.

Why doctors recommend it

A nephrectomy is a surgery to remove all or part of a kidney. Your clinician may recommend this procedure if you have a tumor on your kidney. This includes kidney cancer, also known as renal cell carcinoma, or growths that are not cancerous (benign tumors).

Doctors also suggest this surgery if a kidney is no longer working correctly. A kidney may become severely damaged due to:

• Repeated or chronic infections
• Large or recurring kidney stones
• Severe scarring or birth defects

In some cases, a healthy person may choose to have this surgery to donate a kidney to a family member or another person who needs a transplant.

Urgent vs planned treatment

Most nephrectomies are planned in advance. This gives you and your care team time to prepare and discuss whether to remove the entire kidney (simple or radical nephrectomy) or just the diseased part (partial nephrectomy). Planned surgery is common for treating tumors or for living kidney donation.

In other situations, the surgery may be more urgent. Your clinician may recommend a faster timeline if you have a severe kidney injury from an accident or a life-threatening infection. While most cases allow for careful scheduling, your medical team will determine the timing based on your specific health needs and test results.

Goals of treatment

The primary goal of a nephrectomy is often to treat or prevent the spread of disease. By removing a tumor, doctors aim to stop cancer from moving to other parts of the body. If only a portion of the kidney is removed, the goal is to save as much healthy kidney tissue as possible.

For those with a damaged or non-working kidney, the goal is to improve overall health. Removing a kidney that causes chronic pain or repeated infections can help you feel better and prevent further complications. Success usually means that the remaining healthy kidney takes over the work of filtering waste from your blood, allowing you to lead a normal, healthy life.

Who may benefit

A nephrectomy is a surgery to remove all or part of a kidney. Your clinician may recommend this procedure if you have kidney cancer or a noncancerous (benign) tumor. Removing the affected area can help prevent the spread of disease or stop a growth from causing pain or other health problems.

This surgery may also be an option for people with a kidney that is no longer working correctly. This can happen due to severe scarring, repeated infections, or birth defects that have damaged the organ. Additionally, healthy individuals may choose to have a nephrectomy to donate a kidney to a person in need of a transplant.

When it may not be the right option

Surgery may not be the first choice for everyone. If a kidney tumor is very small and does not seem to be growing quickly, your care team might suggest "active surveillance." This means they will monitor the kidney with regular tests instead of performing surgery right away.

In some cases, a patient’s overall health may make surgery risky. Your clinician may look at other treatments, such as cryoablation (freezing cancer cells) or radiofrequency ablation (using heat to destroy cells). They may also recommend a partial nephrectomy, which removes only the diseased part of the kidney, to help keep as much kidney function as possible.

Questions to ask your care team

It is helpful to talk with your healthcare team to understand your options. You may want to bring a list of questions to your next appointment, such as:

• Why is a nephrectomy the best option for my specific condition?
• Will you be performing a radical nephrectomy (removing the whole kidney) or a partial nephrectomy (removing only a piece)?
• Are there other treatments I should consider before deciding on surgery?
• How will having one kidney affect my long-term health or diet?
• What should I expect during the recovery process?

In the procedure room

When you arrive in the procedure room, the surgical team will help you get positioned comfortably on the operating table. You will likely lie on your side or your back, depending on the specific approach your surgeon has planned. The team will use pillows or foam pads to support your body and protect your skin during the surgery.

The nursing staff will clean the skin around the surgical site with a special soap to help prevent infection. They will also place sticky pads on your chest to monitor your heart and a clip on your finger to check your oxygen levels. This preparation is done to ensure everything is ready and safe before the procedure begins.

High-level steps

There are two main ways a nephrectomy (kidney removal) is performed. Your clinician may use a laparoscopic approach, which involves making a few small cuts and using a tiny camera to see inside. Alternatively, they may perform open surgery, which uses one larger cut in your side or abdomen. The choice depends on your health needs and the reason for the surgery.

During the procedure, the surgeon will:

• Carefully separate the kidney from the nearby organs and tissues.
• Tie off the blood vessels that lead to the kidney to prevent bleeding.
• Disconnect the ureter, which is the tube that carries urine from the kidney to the bladder.
• Remove the entire kidney (radical nephrectomy) or just the damaged part (partial nephrectomy).

Once the kidney or tissue is removed, the surgeon will check the area for any bleeding and then close the incisions with stitches, staples, or surgical glue to help the skin heal.

Anesthesia and pain control

A nephrectomy is performed under general anesthesia. This means you will be in a deep, sleep-like state throughout the entire procedure. You will not feel any pain or be aware of the surgery while it is happening. An anesthesiologist or nurse anesthetist will stay with you the whole time to manage your medicine and keep you comfortable.

To help with pain after you wake up, your clinician may use local numbing medicine around the incision site. They might also provide pain relief through an IV (a small tube in your vein). This helps manage the soreness or pressure you may feel as the anesthesia wears off.

Monitoring and safety steps

Your safety is the top priority during the surgery. The team uses advanced monitors to track your heart rate, blood pressure, and breathing every minute. They also monitor the amount of oxygen in your blood to ensure your body is getting what it needs while you are asleep.

A catheter (a thin, flexible tube) is often placed into your bladder. This allows the team to collect and measure your urine during the surgery. This is an important safety step because it helps the doctors see how well your remaining kidney is functioning in real-time.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery room. As you wake up from the anesthesia, you might feel groggy, chilly, or have a dry mouth. These are very common feelings and usually pass quickly. You may also notice some numbness or a dull ache near the surgical site.

Nurses will check on you frequently to monitor your vital signs and ask about your pain level. If you feel uncomfortable, they can give you medicine to help. You may still have the catheter in your bladder and an IV in your arm to provide fluids and medicine until you are ready to drink on your own.

Typical procedure length

A nephrectomy typically takes between 2 and 4 hours to complete. The exact time can vary based on several factors, such as the surgical method used and your specific anatomy. Your surgical team will keep your family or loved ones updated on your progress during this time.

Common approaches (open vs minimally invasive)

Surgeons perform nephrectomy using general anesthesia, meaning you will be asleep and feel no pain during the procedure. There are two main ways a doctor may reach the kidney.

Laparoscopic surgery (minimally invasive)In this approach, the surgeon makes a few small cuts (incisions) in the abdomen. They insert a wand-like camera and small tools through these cuts to view and remove the kidney. To create space for the surgeon to work, the abdomen is often inflated with gas. In some cases, the surgeon uses a robotic system to control the tools with high precision. This method often leads to a shorter recovery time.

Open surgeryFor this approach, the surgeon makes one larger incision, usually along the side or across the abdomen. This allows the surgeon to directly view and access the kidney. Your care team may recommend this method if the kidney is very large, if there is a large tumor, or if previous surgeries have created scar tissue.

Partial vs total

Depending on the reason for the surgery, your doctor will decide how much of the kidney needs to be removed.

• Radical (total) nephrectomy: This involves removing the entire kidney. In some cases, the surgeon also removes the adrenal gland (which sits on top of the kidney), nearby lymph nodes, and surrounding fatty tissue. This is often necessary when treating certain cancers or severe damage.
• Simple nephrectomy: The surgeon removes the whole kidney but leaves the adrenal gland and lymph nodes in place.
• Partial nephrectomy: Only the diseased part of the kidney, such as a tumor, is removed. The healthy part of the organ is left behind. This approach helps preserve kidney function and is often chosen when the other kidney is not working well or if the tumor is small.

Revision or repeat procedures

While surgeons plan the specific approach before the operation begins, plans may need to change during the procedure to ensure your safety. For example, a surgery that starts as a laparoscopic (minimally invasive) procedure may need to be converted to open surgery.

This switch might happen if the surgeon encounters unexpected bleeding, if the tumor is larger than expected, or if it is difficult to see clearly with the camera. This decision is made to protect your health and ensure the surgery is completed successfully.

Tests and imaging that may be done

Before your surgery, your healthcare team will likely schedule an appointment to check your overall health. This helps ensure your body is ready for the procedure and anesthesia. During this visit, you may have a complete physical exam.

Common tests ordered before a nephrectomy include:

• Blood tests: These check your blood type in case you need a transfusion, as well as how well your kidneys and liver are working.
• Electrocardiogram (ECG or EKG): This test records the electrical activity of your heart to check for any rhythm problems.
• Chest X-ray: This creates a picture of your lungs to check for infection or other issues.

Medication adjustments

Some medications can increase the risk of bleeding during surgery. Your surgeon or nurse will give you a specific list of what to avoid and when to stop taking them. It is common to stop taking the following medicines up to a week or more before surgery:

• Aspirin
• Ibuprofen (Advil, Motrin) and naproxen (Aleve)
• Blood thinners (such as warfarin or clopidogrel)
• Vitamin E and certain herbal supplements

Important: Only stop medicines if your clinician instructs you to do so. In some cases, your doctor may tell you to take essential daily medications on the morning of your surgery with a small sip of water.

Day-before and day-of instructions

Your care team will give you specific rules to follow as your surgery date approaches. Following these steps helps keep you safe during the operation.

The day before surgery:

• Fasting: You will usually be instructed not to eat or drink anything after midnight the night before your procedure. This often includes water, coffee, and gum.
• Smoking: If you smoke, try to stop several weeks before surgery. Quitting helps your breathing during surgery and helps your wounds heal faster afterward.

The day of surgery:

• Arrival: Arrive at the hospital or surgical center at the time listed in your instructions.
• What to bring: Bring your photo ID, insurance card, and a list of your current medications. Leave jewelry and valuables at home.
• Transportation: You will not be allowed to drive yourself home after receiving anesthesia. Arrange for a friend, family member, or responsible adult to drive you home when you are discharged.

General surgical risks

Every surgery involves some level of risk, although serious problems are not common. Your care team takes many steps to keep you safe before, during, and after the operation.

• Reactions to anesthesia: Some patients may have a reaction to the medicines used to put them to sleep, or they may experience trouble breathing.
• Bleeding and infection: As with any major surgery, there is a chance of bleeding or developing an infection at the incision site.
• Blood clots: Surgery can increase the risk of blood clots forming in the legs, which could travel to the lungs.

Procedure-specific complications

Because the kidneys are located deep in the body near other important parts, there are specific risks related to removing a kidney.

• Injury to nearby organs: In rare cases, nearby organs or structures could be accidentally damaged during the procedure.
• Hernia: A hernia is a bulge that can happen if tissue pushes through a weak spot in the muscle where the surgical cut was made.
• Kidney function changes: Most people live a healthy life with one kidney. However, there is a risk that the remaining kidney may not work as well as expected, which could lead to kidney failure in the future.

How complications are treated

Your medical team monitors you closely to catch and treat any issues early. For example, if an infection develops, your clinician may prescribe antibiotics. If there is unexpected bleeding, a blood transfusion might be necessary.

To manage long-term risks, your doctor will likely recommend regular checkups to ensure your remaining kidney stays healthy. This monitoring usually includes checking your:

• Blood pressure
• Protein levels in the urine
• Glomerular filtration rate (a test to see how well your kidney filters waste)

Pain control medicines

After a nephrectomy (surgery to remove all or part of a kidney), your care team will focus on keeping you comfortable. Your clinician may use a combination of different medicines to manage pain. This often includes options like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), which help reduce swelling and discomfort. These are often used to help you feel well enough to move around soon after surgery.

In some cases, stronger medicines called opioids may be used for a short time. Your clinician will tailor your pain plan based on your specific needs and how well your remaining kidney is working. It is important to tell your team about any allergies or past reactions to pain medications to ensure the plan is safe for you.

Antibiotics

To help prevent an infection after surgery, your clinician may give you antibiotics. These are medicines that kill or stop the growth of harmful bacteria. Preventing infection is a key part of a smooth recovery process.

You will likely receive the first dose through an intravenous (IV) line—a small tube in your vein—just before the procedure begins. Depending on your health history and the type of surgery, you might continue taking them for a short time afterward. Your care team will choose the best medicine for you to ensure it does not interfere with other treatments or your kidney function.

Blood thinners and clot prevention

Because you will be less active while recovering, your clinician may use blood thinners, also called anticoagulants, to prevent blood clots from forming in your legs or lungs. These medicines help keep your blood flowing smoothly while you are resting in bed.

You might receive these as small injections under the skin or as pills. Your team will monitor you closely to balance the need for clot prevention with the risk of bleeding. Along with medicine, your clinician may also encourage you to walk soon after surgery and use special leg compression sleeves to help your circulation.

Emergency warning signs

Although serious complications are rare, it is important to act quickly if they occur. Call 911 or go to the nearest emergency room if you experience sudden, severe symptoms such as:

• Trouble breathing: Sudden shortness of breath or chest pain, which could signal a blood clot in the lung.
• Severe bleeding: Bright red blood soaking through your bandages rapidly.
• Loss of consciousness: Fainting or becoming unresponsive.

Call your surgeon or clinic if…

Contact your healthcare provider if you notice signs of infection or other issues during your recovery at home. Your clinician will want to know if you have:

• Fever or chills: A temperature higher than 101°F (38.3°C) or shaking chills.
• Wound changes: Increased redness, swelling, warmth, or foul-smelling drainage coming from your incision (surgical cut).
• Urinary problems: An inability to urinate, burning when you pee, or blood in your urine that does not improve.
• Leg symptoms: Swelling, pain, or tenderness in one of your legs, which may indicate a blood clot.
• Unmanaged pain: Pain that is not relieved by your prescribed pain medicine.
• Digestive issues: Nausea or vomiting that prevents you from drinking fluids or taking your medication.

Expected vs concerning symptoms

Recovering from a kidney removal takes time, and your body will react to the surgery. Knowing the difference between normal healing and a problem can help you stay calm.

Expected: most people feel soreness in the belly area or near the incision site for 1 to 2 weeks. You may also feel more tired than usual and need extra rest.

Concerning: Pain that suddenly gets worse instead of better is a warning sign. While some fatigue is normal, feeling very dizzy, lightheaded, or unable to catch your breath is not expected and requires medical attention.

Non-surgical treatments

In many cases, your clinician may try other treatments before suggesting a nephrectomy (surgery to remove all or part of a kidney). If the kidney is affected by stones or a minor infection, medications or less invasive procedures might be used first. For example, doctors may use sound waves to break up kidney stones so they can pass naturally.

For small growths, your care team might suggest treatments that do not require traditional surgery. These can include:

• Cryoablation: Using extreme cold to freeze and destroy abnormal cells.
• Radiofrequency ablation: Using electrical currents to heat and destroy a small tumor.

Watchful waiting

If a kidney mass is very small or does not appear to be growing quickly, your clinician may recommend watchful waiting. This is also called active surveillance. Instead of having surgery right away, you will have regular check-ups and imaging tests, such as ultrasounds or CT scans, to monitor the kidney closely.

This approach is often used when the risks of surgery might outweigh the benefits. For instance, if a patient is older or has other serious health conditions, monitoring the kidney may be the safest path. If the tests show that the condition is stable and not causing symptoms, surgery may not be needed for a long time, if at all.

When surgery becomes the best option

Surgery usually becomes the best choice when other treatments are no longer effective or if the condition poses a risk to your overall health. Your clinician may recommend a nephrectomy if a tumor begins to grow quickly or if there is a high risk that cancer could spread to other parts of the body.

Other reasons to move forward with surgery include:

• Severe damage from repeated infections or large kidney stones that cannot be treated otherwise.
• A kidney that is no longer working and is causing high blood pressure or chronic pain.
• The need to remove a healthy kidney for a transplant to help a person in need.

Hospital services that commonly perform this surgery

A nephrectomy (surgery to remove all or part of a kidney) is usually performed in a hospital's urology department. Urology is the branch of medicine focused on the health of the urinary tract and kidneys. These departments have specialized surgical teams trained to handle both simple and complex kidney procedures.

Your clinician may also refer you to a specialized surgery center or a large medical center that focuses on kidney health. These facilities often have advanced technology, such as robotic-assisted tools, which may allow for smaller incisions and a faster recovery time. These centers are equipped to handle everything from kidney cancer treatments to living kidney donations.

Patient resources and support services

Many hospitals provide resources to help you prepare for surgery and manage your recovery. This often includes pre-operative education, where a nurse or educator explains what to expect before, during, and after the procedure. They may provide booklets or videos to help you feel more comfortable with the process.

Support services may also include:

• Social workers: They can help with planning for your care at home or finding local resources if you need extra help during recovery.
• Financial counselors: These professionals can help you understand your insurance coverage and hospital billing.
• Nutritionists: If you are having a kidney removed, a dietitian may help you plan a kidney-friendly diet to keep your remaining kidney healthy.

Questions for choosing where to have surgery

Choosing where to have your surgery is an important step. You may want to ask your clinician or the hospital staff the following questions to help you make a decision:

• How many nephrectomies does this hospital perform each year?
• Does the surgeon specialize in laparoscopic (minimally invasive) or robotic surgery?
• What kind of support is available if I have questions during my recovery at home?
• Does the facility have a dedicated unit for patients recovering from kidney or urinary surgeries?
• How long is the typical hospital stay for this procedure at this facility?

Conditions commonly treated by this procedure

A nephrectomy is a surgery to remove all or part of a kidney. Your clinician may recommend this procedure to treat several different health issues. The most common reason is to treat kidney cancer, such as renal cell carcinoma. It may also be used for noncancerous (benign) tumors that are causing health problems.

Other conditions that might lead to this surgery include:

• Severe kidney damage caused by long-term infections or large kidney stones.
• Birth defects that prevent the kidney from working correctly.
• Traumatic injury to the kidney that cannot be repaired.
• Kidney failure, if the damaged kidney is causing complications like high blood pressure or chronic pain.

In some cases, a healthy person may choose to have a nephrectomy to donate a kidney to someone who needs a transplant. This is known as a living donor nephrectomy.

Related symptoms people search for

Many people who require a nephrectomy first notice symptoms that affect their urinary system or general health. These signs do not always mean you have a serious kidney problem, but they should be evaluated by a healthcare professional to find the cause.

Common symptoms that may be associated with kidney conditions include:

• Blood in the urine, which may look pink, red, or tea-colored.
• A dull ache or sharp pain in the side, back, or abdomen (often called flank pain).
• A lump or mass that can be felt in the side or belly area.
• Persistent high blood pressure that does not respond well to medication.
• General symptoms like feeling very tired, losing weight without trying, or having a fever that does not go away.

Evidence overview

Nephrectomy is a well-established surgical procedure used to treat kidney cancer, remove a severely damaged or infected kidney, or harvest a healthy kidney for donation. Medical evidence supports two main surgical approaches: open surgery, which uses a single large incision, and laparoscopic surgery, which uses small incisions and a camera. In some cases, robot-assisted technology is used to help perform the surgery with precision.

Studies indicate that removing only the diseased part of the kidney (partial nephrectomy) is often as effective as removing the entire organ, depending on the patient's condition. This approach helps preserve overall kidney function. When a complete removal (radical nephrectomy) is necessary, evidence shows that the remaining healthy kidney is usually able to increase its function to filter waste for the entire body.

Safety notes and individualized care

While nephrectomy is generally safe, it carries risks common to major surgeries. These can include bleeding, infection, or reactions to anesthesia. Specific risks related to kidney surgery may include injury to nearby organs or the development of a hernia near the incision site. Your healthcare team will discuss these possibilities with you and take steps to manage them.

Your care plan will be tailored to your specific health needs. Your clinician will decide whether open or laparoscopic surgery is safer for you based on factors such as the reason for the surgery and your medical history. Following the procedure, long-term monitoring is often recommended. This usually involves regular checkups to measure blood pressure and kidney function, ensuring your remaining kidney stays healthy.

Sources used

The content in this section is grounded in medical overviews from major academic medical centers and government health libraries. These sources provide standard information regarding surgical techniques, potential complications, and recovery expectations for patients undergoing kidney removal.