Nephrectomy (kidney removal): why it is done, recovery and living with one kidney

A nephrectomy is the surgical removal of a kidney or part of a kidney. The NHS names two main types in its page on kidney cancer treatment: removing a kidney (nephrectomy) and removing the cancer but leaving as much of the kidney as possible (partial nephrectomy). Cancer Research UK uses the terms radical nephrectomy for removal of the whole kidney and partial nephrectomy for removal of the part where the cancer is.

The choice depends on the size of the cancer and whether it has spread, together with your general health. You may also need some lymph nodes removed, the NHS says. The sources used in this guide focus on kidney cancer, which is the most common reason for the operation discussed in UK patient information.

Surgery is the main treatment for kidney cancer that has not spread to other parts of the body, according to Cancer Research UK. The NHS says that if kidney cancer is found early and has not spread you may be able to have surgery to remove it, and that treatment depends on the type of kidney cancer, where it is and how big it is, whether it has spread and your general health.

Often there are no obvious symptoms of kidney cancer, and the NHS says it is usually diagnosed when testing for something else. When there are symptoms they can include blood in your pee, a lump or swelling in your back, under your ribs or in your neck, pain between the ribs and waist that does not go away, loss of appetite or weight loss, tiredness, a high temperature that does not go away and heavy sweating. These can be caused by many other conditions, but should be checked by a GP.

A nephrectomy is also the operation a living donor has to give a kidney to someone waiting for a transplant. NHS Organ Donation says the kidney is usually removed by keyhole surgery under general anaesthetic, with 2 to 4 keyhole wounds of around 1cm and, depending on the technique, a slightly longer scar where the kidney was removed.

It says the operation usually takes around 2 to 3 hours, most people stay in hospital for 3 to 4 days, and after donating you should not need any long-term medication.

Not everyone can or wants to have surgery. The NHS lists other treatments for kidney cancer that may be used instead of, or alongside, surgery, depending on the situation.

Before the operation you meet members of your healthcare team, who tell you how to prepare, and you may have some tests. Cancer Research UK says that after the operation you wake up in the recovery room with one-to-one nursing care. Sometimes you wake up in intensive care or a high dependency unit, for example if your general health is poor or the operation was longer or more complicated than planned, and you usually move back to the ward within a day or so.

You may have several tubes and drains after surgery: drips for fluids and painkillers, one or more drains in your back or side to stop blood and fluid collecting, and a catheter so your urine can be measured. Your nurse checks blood pressure and urine output regularly. Drains are usually taken out 3 to 7 days after the operation.

With keyhole surgery you have 3 or more small wounds on the side of the operation, each about 1cm long except the lowest, which is normally about 6 to 8cm so the surgeon can remove the kidney or part of it. With open surgery on the left kidney the wound normally looks like the letter L, starting just under the ribs and going down to the belly button and around to the left side.

Cancer Research UK says it is normal to have pain for the first week or so, and you are given painkillers, sometimes through a drip you control or through a thin tube in your back connected to a pump (an epidural). Moving about helps you get better quicker and reduces the chance of a chest infection or blood clot. The bowel may be slow for a while, and you start with water before moving on to other drinks and food.

Cancer Research UK says when you can go home depends on the type of operation and how well you are recovering. Problems after kidney cancer surgery can include infection and bleeding, and there is a risk of complications after any operation; many are minor but some are more serious. The NHS’s kidney cancer pages say the specialist care team will explain the treatments, benefits and side effects, work with you on a plan, and help you manage side effects.

The sources read do not set out a detailed timetable for returning to work or driving, which varies with the type of operation, so ask your surgical team for written advice. If you have questions about living with one kidney, or about long-term kidney function monitoring, ask your surgeon or specialist nurse.

Yes. Kidney Research UK says one kidney can sometimes do the work of two, and that some people who have had one kidney removed have increased function in the remaining kidney, equating to around 70% of that normally achieved by two kidneys. NHS Organ Donation says most people living with one kidney are able to live long, healthy lives.

Kidney Research UK says people with one kidney are generally followed up more closely, with a urine test and blood pressure check yearly and kidney function checked every few years. There is a slightly higher chance of a small rise in blood pressure or protein in the urine, but the decrease in kidney function is usually mild and life span is normal.

Because a single kidney can be more vulnerable to injury, Kidney Research UK advises care with heavy contact sports such as boxing, football, hockey and martial arts, and says to seek medical advice first and wear protective padding if you still want to play. In general, people with one healthy kidney do not need a special diet: a healthy, well-balanced diet and reducing salt are recommended.

On the NHS, suspected kidney cancer is referred by the GP to a specialist team, and treatment is planned with a team that includes a clinical nurse specialist. Care is free at the point of use. The NHS notes that if you have been told the cancer cannot be cured, a palliative care or symptom control team will work with you.

Some people use private urology for quicker access to surgery or a second opinion. The operation is broadly the same, and the main differences are waiting time, cost and surgeon choice. Ask which surgical approaches the surgeon offers (partial or radical, keyhole or open) and what follow-up is included.