Nephrectomy

What you should know

• A nephrectomy (ne-FREK-to-me) is surgery to remove all or part of your kidney. The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen. The kidneys remove wastes and other unwanted chemicals from the body. These wastes are flushed from the body in the form of urine. Above each kidney is an adrenal gland, which is an organ that makes hormones. Hormones are special substances that control some functions of your body. These adrenal glands may also be removed during nephrectomy.
  
  
• You may need a nephrectomy when your kidney is damaged. This may be caused by clogged blood vessels, kidney stones, infection, or kidney cancer. These conditions decrease your kidney's ability to control blood pressure and to completely remove harmful wastes from your body. With nephrectomy, your kidney problem may be treated and further damage to your remaining kidney prevented. Your signs and symptoms may decrease and you may resume your usual activities.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• There are always risks with surgery, such as infection or bleeding too much. You may have trouble breathing or get blood clots. Nerves, blood vessels, muscles, and intestines may be damaged. Even after a successful surgery, the remaining kidney may not be able to function as well as before. If you have kidney cancer, some cancer cells may have already spread to other parts of your body.
  
  
• If left untreated, your kidney problem may get worse. If you have kidney cancer, the cancer cells may spread to other areas of your body. These may cause fever, weight loss, weakness, high blood pressure, and decreased amounts of red blood cells. This may affect its ability to completely remove harmful wastes from your body. Too much of these harmful wastes may cause dizziness, headache, seizures, confusion, or fainting. These conditions may cause death, if not diagnosed and treated as soon as possible. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• If you are a woman, tell your caregiver if you know or think you are pregnant.
  
  
• You may need to have different blood and urine tests. Imaging tests, such as x-rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI), or renal arteriography may also be done. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the room where the surgery will be done. A medicine called general anesthesia will be given to keep you asleep and free from pain during the surgery. You will be placed on your back or turned to your side when you are asleep. Your skin will be cleaned and covered with clean sheets to keep the surgery area clean.
  
  
• An incision (cut) will be made along your side or across your abdomen to reach your kidney. Once it is seen, the blood vessels attached to it will be cut and tied. The affected kidney will be removed by carefully cutting tissues covering and sticking to it. Your caregiver will remove all or part of your kidney. Your adrenal gland may also be removed. Your caregiver will carefully check the surrounding areas for cancer or other problems. The incisions will be closed with stitches (threads) and covered with a bandage.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches will keep the area clean and dry to prevent infection. A caregiver may remove the bandages to check your wound.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• The problems for which you are having the nephrectomy get worse.