A nephrectomy is a surgery to remove all or part of a kidney. This procedure is usually done to treat kidney damage or diseases like kidney cancer. It can also be performed to remove a healthy kidney from a donor for transplant.

Surgical approaches for nephrectomy include a traditional open surgery, laparoscopic surgery, or robotic surgery. Full recovery can take up to six weeks.

This article provides an overview of nephrectomy and discusses what to expect before, during, and after surgery.

What Is a Nephrectomy?

Nephrectomy is the partial or complete removal of a kidney. It is performed by a urologic surgeon. The goal is to remove the diseased or damaged part of the kidney, or the entire kidney in certain situations.1

The main types of nephrectomy include:2

• Partial nephrectomy, where just the diseased or damaged part of the kidney is removed.
• Simple nephrectomy, where the entire kidney is removed. This is typically performed for donor situations or certain stages of kidney cancer.
• Radical nephrectomy, where the entire kidney plus the adrenal glands, lymph nodes, and some surrounding tissue are removed.

Options for surgical techniques include:3

• Open nephrectomy: This traditional surgery involves making a long incision to remove the kidney. It may be preferred if the damage is extensive or complex.
• Laparoscopic nephrectomy: This minimally invasive procedure involves making small incisions along the abdomen and using special instruments to perform the nephrectomy. Because of shorter recovery periods, a laparoscopic nephrectomy may be preferred to an open nephrectomy whenever possible.
• Robotic nephrectomy: Similar to a laparoscopic procedure, this technique is performed with the use of robotic assistance for partial nephrectomy surgeries. It may be considered for patients with smaller kidney tumors.

Because it involves removing a main organ, a nephrectomy is an inpatient procedure, meaning it requires an overnight hospital stay. Nephrectomy can be done on an emergency basis if there is sudden trauma or disease to the kidney, or as a scheduled procedure in the event of a planned kidney donation.

Contraindications

Nephrectomy is considered on a case-by-case basis for adults and children. It depends on several factors, including:

• Patient’s overall health
• Disease or damage severity
• Need for a transplant donor
• Size, location, and stage of the tumor

As with any surgery, there may be some patients who aren’t good candidates for a nephrectomy. In general, nephrectomy would not be an option for people who:4

• Cannot tolerate a general anesthetic
• Have had multiple surgeries via the abdomen
• Have severe heart or lung disease
• Have a history of cirrhosis or poor kidney function 
• Have an uncontrollable bleeding disorder
• Are on blood thinner medications

Other factors may also play a role in the decision to undergo a nephrectomy. Ultimately, your medical team will provide a recommendation on whether it’s likely to be a safe and effective procedure for you.

Potential Risks

Like all surgeries, a nephrectomy has the potential to pose risks to your health, including:5

• Infection
• Bleeding
• Injury to nearby tissue or organ
• Allergic reaction to the anesthesia
• Blood clots
• Post-operative wounds and pain
• Post-operative pneumonia

Specifically for nephrectomy, there is a risk for kidney disease or failure in the remaining kidney. You can still live with one kidney, as long as it’s healthy and functioning.

Purpose of a Nephrectomy

A nephrectomy is performed to remove all or part of a kidney in several different circumstances, including:

• Kidney cancer
• Damage from kidney disease or kidney stones
• Damage from an accident or trauma
• Birth defects
• Kidney transplant donation

During an open nephrectomy, all or part of the kidney is removed through a large incision made along the abdomen. With a laparoscopic or robotic nephrectomy, small incisions are made along the abdomen to allow surgical instruments access to the diseased or damaged part of the kidney. Both are performed under general anesthesia.

Before a nephrectomy, you’ll be required to take certain tests to ensure you’re healthy enough to undergo the procedure, or healthy enough to donate a kidney to someone else. These may include:6

• Chest X-ray
• Electrocardiogram
• Blood tests
• Urinalysis
• Vital signs assessment, such as blood pressure, heart rate, body temperature, and oxygen saturation
• Negative tests results for HIV, hepatitis, or other serious medical conditions (for living kidney donors)

How to Prepare

Several steps need to be taken before having a nephrectomy, and preparation may be slightly different for each person. Your surgeon’s office will schedule the procedure in advance and let you know what you need to do to prepare for surgery.

You should expect to take several weeks off from work and other obligations for the surgery itself and the recovery period.

Location

A nephrectomy takes place in a standard hospital operating room and will require a hospital stay of up to a week post-surgery. You’ll be told what time to arrive at the location to check-in and get settled before the surgery.

What to Wear

Plan to arrive wearing loose-fitting, comfortable clothes that are easy to change out of. You’ll be wearing a hospital gown for the surgery and most of the hospital stay, but you may want to bring your own socks, slippers, robe, or comfortable sweatpants.

Food and Drink

Because a nephrectomy involves anesthesia, there will be certain food and drink restrictions before the surgery. Your surgeon will likely direct you not to eat or drink anything after midnight the night before the procedure.

If you’ve been told it’s safe to continue taking any routine prescription medications, you may take them with a small sip of water.

Medications

Before the procedure, you may have to stop taking some medications. Certain classes of drugs—like nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants (blood thinners)—cause increased bleeding and can interfere with wound healing.7

You may also need to start a course of antibiotics prior to surgery. Your surgeon will give you instructions on what to do concerning your current medications and prescribe any that are needed before surgery.

What to Bring

Plan on packing basic care items for the hospital stay after your nephrectomy, but don’t wear any jewelry and leave anything of value at home. Your packing list may include items like:

• Personal toiletries
• Change of comfortable clothing
• Eyeglasses or contact lenses
• Cell phone and charger
• Book or activity to pass the time
• Photo identification (driver’s license or government ID)
• Insurance card

You’ll also need to schedule a ride home from the hospital with a responsible adult. The anesthesia given during the procedure will make it dangerous for you to drive.

Pre-Op Lifestyle Changes

Your surgeon will encourage you to stop smoking at least two weeks before and after surgery. Cigarette smoke affects blood vessels, reducing the amount of blood and oxygen that reaches the surgical wound. This not only slows down healing but increases the risk of treatment failure.

What to Expect on the Day of Surgery

On the days leading up to surgery, expect to be in touch with the surgical team and other healthcare professionals from the hospital. They’ll keep you updated on preparing for the nephrectomy and will be available to answer any last-minute questions you may have.

Before the Surgery

On the day of your surgery, you will arrive at the hospital to check-in at a specified time. This is when you’ll fill out paperwork or remaining medical forms before being taken back to a pre-operative room to get ready. 

Then, you’ll change out of your clothes into a hospital gown. A nurse will review your medication list, record your vitals (blood pressure, heart rate, and temperature) and place an intravenous (IV) line into a vein in your arm or hand. Fluids and any medications needed will be administered through that IV line. 

Shortly before the nephrectomy, your surgeon will come to greet you, explain the procedure in detail, and go over the risks involved. You’ll be asked to sign a consent form authorizing the surgery and indicating that you understand the potential risks involved. 

From there, you will be wheeled into the operating room. Your anesthesia provider will first give you an IV sedative to help you relax and ensure you can’t move or feel pain during the procedure. Then, a breathing tube (endotracheal tube) will be inserted through your mouth and into your windpipe to help you breathe during the procedure. A catheter is also placed in the urethra to collect urine. 

The surgical staff will swab your abdomen with an antiseptic solution that kills germs and put a drape around the surgical area to prevent infections.

After you’re fully under anesthesia, your surgery will begin.

During the Surgery

Your nephrectomy may be an open surgery or a laparoscopic surgery or robotic surgery. After the entire or partial kidney is removed, the incisions will be closed with stitches or staples, and dressings will be placed to keep them clean and dry.5

The procedure can take three or more hours, and the surgeon will be assisted with a team of healthcare providers and nurses. Throughout the entire process, you will be under anesthesia, meaning you will be asleep and unable to feel pain.

After the Surgery

Once the nephrectomy is complete, the anesthesia will be stopped and you will slowly begin to wake up. You’ll be wheeled to a recovery room for a few hours, where you’ll feel groggy and possibly experience some pain as you start to become more alert.

During this time, a nurse will monitor your vital signs. Once you’re awake and your blood pressure, pulse, and breathing are stable, you’ll be moved to your hospital room to begin recovering.

A medical team will closely monitor your:5

• Kidney function
• Blood pressure
• Electrolytes
• Fluid balance

The IV will stay in place so you can receive medications and fluids for the remainder of your hospital stay. The urinary catheter will also remain in place until you’re able to get out of bed and walk to the bathroom. Your diet will start with liquids and advance to solids as the recovery period continues.

Recovery

A nephrectomy is a major operation, and your body will need time to regain its normal function and fully heal. Certain factors can increase or decrease recovery times, including:

• The surgical technique used
• Your overall health
• How well you care for your surgical wound
• Whether or not you smoke

Healing

While most patients can expect to return home from the hospital within a week or so, full healing from a nephrectomy generally takes around three to six weeks.8

As part of the healing process and promotion of normal physical functions shortly after the surgery, you can expect to:9

• Be asked to sit on the side of the bed and start walking
• Not be able to eat for the first day or two, then progress to a liquid diet
• Not be able to shower for the first day or two
• Have a catheter that comes from your bladder
• Have a drain that comes out through your surgical cut

During this initial healing period, it’s important that you:

• Keep your incision area clean, dry, and protected
• Do not soak in a bathtub
• Do not attempt to lift anything heavier than 10 pounds

After a nephrectomy, you will feel pain at the surgical site and will likely notice bruising or redness around the incisions. This is normal.10 Your medical team will work with you to manage post-surgical pain or other symptoms with medications.

Coping With Recovery

Having a kidney (or part of it) removed can feel like a long, overwhelming, and stressful experience. While you will need help with everyday activities for the first few weeks, keep in mind that you should be able to return to most of your regular routine after four to six weeks (with your healthcare provider’s permission).

Until then, here are a few tips to help you cope:

• Set up your home so it’s easy to maneuver and use during the recovery period.
• Avoid any strenuous activity until your healthcare provider clears you for exercise.
• Eat a healthy diet once you are able to, and make sure to drink plenty of water each day.
• Slowly incorporate gentle movement like short walks, stair use, and light housework as needed.
• Don’t suffer in pain or discomfort and notify your healthcare provider if your post-surgery medication protocol is causing side effects or isn’t bringing you relief.

Perhaps most importantly, don’t push yourself too hard. It’s important to avoid any undue stress at this point in the recovery process.

Long-Term Care

After a nephrectomy, you’ll need to check-in with your healthcare provider more often. Your surgeon will want to meet with you several times after the surgery to make sure you’re recovering properly.

You can also expect regular follow-up visits in the weeks, months, and years post-surgery, where your healthcare provider will continue to monitor your kidney function.

Lifestyle Adjustments

After a nephrectomy or partial nephrectomy, your healthcare provider will want to make sure you maintain normal overall kidney function. To this end, they may make recommendations for lifestyle adjustments, such as:5

• Maintaining a healthy diet to manage your weight, blood sugar levels, and proper balance of minerals.
• Drinking adequate amounts of water each day.
• Beginning or resuming a regular exercise plan to help control blood pressure and increase muscle strength.
• Stopping or limiting participation in contact sports to protect the remaining kidney.

Summary

A nephrectomy is a surgery to remove all or part of a kidney. It’s typically necessary for people with kidney cancer, kidney disease, a damaged kidney, or a kidney tumor. This surgery can also be performed if your kidney is getting donated for transplant. After a nephrectomy, you’ll be required to stay in the hospital for up to a week. Full recovery can take up to six weeks.