A nephrectomy is the surgical removal of a kidney. In many cases, this is performed as a laparoscopic procedure. Occasionally, it may be performed as an open procedure which requires a larger incision and increased recovery time. It may be necessary due to kidney tumours, cancer, or end-stage kidney disease. This procedure is also used to remove a health kidney from a donor for use in transplantation. A radical nephrectomy is the removal of the kidney, associated glands, ureters and surrounding tissue. Partial nephrectomies remove only the affected portion of the kidney and are also known as a kidney-sparing procedures.
As with any surgical procedure performed under anaesthesia, there is the risk of certain side effects after a nephrectomy. An adverse reaction to anaesthesia is apparent immediately upon induction or upon recovery. This is a medical emergency and will be treated by the anaesthesiologist monitoring the administration. Then, of course, there will be pain in the procedural area which may be mild to severe in nature and can last up to three weeks. Any sudden, unusual pain should be reported to the surgeon immediately. There is the risk of developing post-operative pneumonia as it is difficult to breathe effectively due to the pain. It is important to take deep breaths and cough to clear the lungs after surgery. Breathing exercises and pain control are important in reducing the risk of developing pneumonia after a nephrectomy.
A laparoscopic nephrectomy is not nearly as invasive as an open procedure; however, the risk for infection after the procedure still exists. Infection originating from the urinary bladder may be due to the use of an indwelling urinary catheter. The catheter may be used for a short period of time to aid in emptying the bladder during the recovery period. Failure to manage the catheter in a clean manner can lead to the development of a bladder infection. The infection may spread to the healing nephrectomy site if not treated quickly. An infection may occur at the wound site itself. Careful wound care must be carried out to reduce the risk of infection. Any indication of infection should be treated as an urgent matter requiring the attention of the surgeon.
A radical nephrectomy involves disconnecting the kidney from the major renal blood vessels. While surgeons take special care in suturing the ends of these vessels, there is always the possibility of haemorrhage. There are also other major vessels in close proximity to the kidneys and any of these may be inadvertently nicked during the procedure. Immediately after the procedure and during recovery in the hospital, close attention is paid to identify any possible signs of haemorrhage. Decreasing blood pressure may indicate there is bleeding, so it is important to report any signs of dizziness or change in mental status.
The kidneys and associated glands help to regulate blood pressure. When one or both kidneys are removed, blood pressure must be monitored closely and managed proactively as high blood pressure, or hypertension, is a side effect of nephrectomy. The severity depends on the health of the remaining kidney, if there is one, and lifestyle management. Decreasing sodium intake is one important change to make after having a nephrectomy. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends maintaining a blood pressure lower than 130/80 for those people living with one kidney. Failure to control blood pressure can cause damage to the remaining kidney.
When one kidney is removed, the remaining kidney compensates and works harder. Even with a partial nephrectomy, compensation takes place as there is less of one kidney to carry out the full workload required by the body. The workload of the remaining kidney can be decreased by reducing protein intake as the kidney is responsible for removing the waste products of protein metabolism. Over time, the increased work can cause damage that can progress to the development of kidney disease. After a nephrectomy, blood work and urine analysis will be routinely performed to monitor the function of the remaining kidney, or kidneys. Increasing levels of protein in the urine may indicate the presence of kidney disease.
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