Kidney removal surgery (Radical nephrectomy)

What is radical nephrectomy?

Radical nephrectomy is removal of an entire kidney together with the surrounding fat (Gerota’s fascia) and sometimes the adjacent adrenal gland and lymph nodes. It is most often performed for kidney cancer (e.g. renal cell carcinoma, Wilms tumour in children) but may also be needed for severe kidney trauma, polycystic kidney disease with pain or infection, a non-functioning or severely diseased kidney, or as part of preparation for a kidney transplant. The remaining kidney usually compensates so that dialysis is not needed, but lifelong follow-up is important to protect kidney function.

When is kidney removal needed?

Indications include:

• Kidney cancer: large or invasive tumours, or cancer that has spread beyond the kidney.
• Severe trauma: irreparable damage from blunt or penetrating injury (e.g. road traffic accident, stab or gunshot wound).
• Polycystic kidney disease: when cysts cause severe pain, recurrent infection, or progression to kidney failure.
• Non-functioning or severely diseased kidney: chronic infection, large stones, or congenital abnormality causing pain, high blood pressure, or recurrent infection.
• Preparation for transplant: removal of a diseased kidney when the other is healthy enough to work alone or when a transplant is planned.

Surgical approaches

Open nephrectomy uses a single large incision (often 8–12 inches) and gives direct access to the kidney; it may be chosen for very large tumours or when surrounding structures need to be removed. Laparoscopic nephrectomy uses several small incisions and a camera; recovery is often faster with less pain and a shorter stay. Robotic-assisted nephrectomy offers enhanced precision and may reduce blood loss. The choice depends on tumour size, anatomy, your general health, and the surgeon’s experience. Before surgery, imaging (e.g. CT, MRI), blood tests, and sometimes a biopsy are used to plan the operation.

Recovery and life with one kidney

Most people recover within 4 to 6 weeks (often 2–4 weeks after laparoscopic or robotic surgery). You will be advised to avoid heavy lifting and strenuous activity for a period. The remaining kidney usually enlarges slightly (compensatory hypertrophy) and takes over filtration. To protect it: stay well hydrated, eat a balanced diet low in excess salt and processed foods, control blood pressure, and attend regular follow-up to check kidney function. Dialysis is not usually needed unless the other kidney is already damaged (e.g. by diabetes or hypertension) or complications occur.