Nephrectomy is the surgical removal of a kidney. Possible indications for surgical removal of the kidney include renal infarction or organ malformation.
What is a nephrectomy?
Nephrectomy is the surgical removal of a kidney. Nephrectomy is the surgical removal of a kidney. Kidneys are paired organs. They are bean-shaped, 10 to 12 centimeters long and 4 to 6 centimeters wide. Their weight varies between 120 and 200 grams. The main function of the kidneys is urine formation. This requires filtration, reabsorption and concentration of urine. In addition, the kidney is involved in the regulation of water and electrolyte balance and acid-base balance. The first nephrectomy was performed by surgeon Gustav Simon in Heidelberg on August 2, 1869. Prior to the human procedure, Simon had practiced nephrectomy on animals several times. With the first nephrectomy, Gustav Simon proved that a healthy kidney was sufficient to take over urine excretion. Previously, it was assumed that humans were not viable with only one kidney.
Function, effect, and goals
One indication for surgical removal of the kidney is renal infarction. Renal infarction is necrosis of kidney tissue that has occurred due to impaired blood flow and hypoxia (ischemia). Often, renal infarction is caused by thrombosis. This can occur due to atrial fibrillation, aneurysms of the heart wall, heart valve replacement, or inflammation of the inner lining of the heart. Venous thrombosis can also cause renal infarction. In this case, the underlying cause is usually right heart failure. However, compression of the renal veins by a renal tumor is also a possible cause. Another indication for nephrectomy is recurrent kidney inflammation (nephritis). Nephritis usually involves inflammation of the renal functional tissue and the renal pelvis. In most cases, nephritides are caused by ascending infections from the urinary tract. Kidney and urinary stones, diabetes mellitus, malformations and painkiller abuse have a favorable effect. Severe cases of kidney stones (nephrolithiasis) may also require removal of the kidney. Furthermore, nephrectomy may be indicated for hydronephrosis. Hydronephrosis is an abnormal dilatation of the renal pelvis. This dilatation causes a urinary outflow obstruction. The renal pelvis is distended, while the renal parenchyma is narrowed. This phenomenon is also known as aqueous sac kidney. Hydronephrosis can be congenital or acquired. Causes of secondary, i.e. acquired, hydronephrosis include obstruction of the urinary tract by stones, carcinoma of the ureter, diseases of the female reproductive organs or diseases of the urinary bladder. Severe organ malformations also require nephrectomy. The same is true for malignant kidney diseases. Kidney tumors are often incidental findings. About 90 percent of all malignant kidney tumors are renal cell carcinomas. More rarely, benign tumors or so-called oncocytomas are found. Larger or centrally located tumors are removed in a radical nephrectomy. In radical nephrectomy, the entire kidney is removed. The procedure can be done open surgically or laparoscopically. Until a few years ago, open radical nephrectomy was the treatment procedure of choice for kidney tumors. Today, laparoscopic nephrectomy is preferred. Open surgery is performed when laparoscopic removal is not possible due to the size of the tumor or previous surgery. The surgery can be performed in a hyperextended lateral position (retroperitoneal) or in a supine position through an abdominal incision (transperitoneal). The renal vessels are clamped so that the blood supply is cut off. The kidney is then removed along with the fat capsule. The lymph nodes and adrenal gland may also be removed. The adrenal gland sits on top of the kidney. Unlike the kidney, it is not responsible for urine production, but for hormone production. Patients can usually be discharged after 8 to 10 days following a nephrectomy.
Risks, side effects, and hazards
Surgery, and therefore nephrectomy, is always associated with risks. During the course of the operation, the cardiovascular system may be disturbed.Since anesthesia switches off the body’s protective reflexes, stomach contents can enter the throat, trachea or lungs under unfavorable conditions. This can result in the development of what is known as aspiration pneumonia. During intubation at the beginning or extubation at the end of anesthesia, a spasm of the glottis may occur in rare cases. The endotracheal tube or laryngeal mask irritates the throat and vocal cords. Therefore, hoarseness and coughing may occur after surgery. In rare cases, vocal cord damage may remain. Occasionally, the front teeth of the upper jaw are damaged when the laryngoscope is inserted. 20 to 30 percent of all patients also suffer from nausea and vomiting after anesthesia. Although only a small scar may remain after the procedure, a period of rest and recovery of 4 to 6 weeks after surgery is necessary. During the first 4 to 6 weeks after surgery, the risk of thrombosis is increased. Pain in the hip, leg or ankle as well as swelling of the legs should always be considered as warning signs. As a result of leg vein thrombosis, a life-threatening pulmonary embolism may develop. After nephrectomy, the remaining kidney must compensate for the loss of kidney function. Therefore, it usually enlarges. As a rule, this process proceeds without problems. Nevertheless, laboratory values should be checked regularly by the physician. In particular, the glomerular filtration rate (GFR), creatinine clearance and creatinine value should be monitored. Monitoring by the internist is also recommended. If necessary, the latter can initiate dialysis in good time if the function of the single kidney is impaired.
