A nephrectomy is surgery to remove all or part of a kidney. It is most commonly performed to treat kidney tumors, but it is also the procedure used when someone donates a kidney to another person. Depending on the reason for surgery and the approach used, recovery can range from a few weeks to a few months.
Why a Nephrectomy Is Performed
The most common reason is to remove a kidney tumor, which may be cancerous or noncancerous. For kidney cancer, a nephrectomy can be lifesaving, and it is often the primary treatment rather than a step before other therapies.
Beyond tumors, a surgeon may recommend the procedure if you have recurrent kidney infections that don’t respond to other treatments, a kidney that has stopped functioning and is causing problems like pain or high blood pressure, or conditions such as polycystic kidney disease. It is also the surgery performed on living kidney donors.
Types of Nephrectomy
There are three main types, and the one your surgeon recommends depends on how much tissue needs to come out.
- Partial nephrectomy: Only the diseased portion of the kidney is removed, leaving the rest intact. This is the preferred approach for smaller tumors (generally 4 cm or less) because it preserves more kidney function and lowers the risk of chronic kidney disease down the road.
- Simple nephrectomy: The entire kidney is removed, but nothing else around it. This is typical for non-cancer situations like a nonfunctioning kidney or a living donor surgery.
- Radical nephrectomy: The entire kidney is removed along with the surrounding fatty tissue, the layer of connective tissue that encases it, and sometimes the adrenal gland sitting on top. This is the standard approach for larger or more aggressive kidney cancers.
For tumors in the middle size range (roughly 4 to 7 cm), the choice between partial and radical nephrectomy is less clear-cut. Studies show similar cancer control and survival rates for both options in this range, though partial nephrectomy carries a slightly higher chance of positive surgical margins while radical nephrectomy removes more functional kidney tissue. Your surgeon will weigh these tradeoffs based on the tumor’s location and your overall kidney health.
Open, Laparoscopic, and Robotic Approaches
Any of the three nephrectomy types can be done through different surgical approaches. An open nephrectomy uses a single large incision, typically along the side or abdomen. Laparoscopic nephrectomy uses several small incisions and a camera to guide the surgery. Robotic-assisted nephrectomy is similar to laparoscopic but uses a robotic system that gives the surgeon enhanced precision and a magnified 3D view.
The practical differences between laparoscopic and robotic approaches are small. Both have a median hospital stay of about two days, and both require blood transfusions far less often than open surgery (roughly 3 to 4% compared to nearly 12% for open procedures). Robotic surgery is about 15% more expensive, and large comparative studies have found no clear clinical advantage of one minimally invasive technique over the other. Open surgery is still used when the tumor is especially large, complex, or involves surrounding structures, but minimally invasive approaches have become the default for most cases.
What Recovery Looks Like
After a robotic or laparoscopic partial nephrectomy, most people spend one to two nights in the hospital. An open partial nephrectomy typically means three to four days. For the first several days at home, you won’t be able to lift anything, and it helps to have someone around to assist with daily tasks.
Return to desk work is realistic about four weeks after surgery. Resuming strenuous activity takes longer. After a robotic procedure, most people are back to normal activities in four to six weeks. After an open procedure, that timeline stretches to eight to twelve weeks. Your surgeon will give you specific restrictions, but the general pattern is a steady return to normal over one to three months.
Risks and Complications
Overall complication rates for nephrectomy range from about 12 to 36%, though most complications are manageable and resolve without lasting consequences. The most common issues after a radical nephrectomy include bleeding (around 9%), temporary kidney function decline (about 9%), infection (roughly 8%), and post-surgical anemia (about 6%). Partial nephrectomy has a similar profile, with bleeding being the most frequent complication at around 12%.
Minimally invasive approaches generally have lower complication rates than open surgery across most categories. Serious complications like organ injury or the need for a second surgery are uncommon with any approach.
How Your Remaining Kidney Adapts
If you lose an entire kidney, the remaining one compensates remarkably well. Within eight to twelve weeks, the remaining kidney’s filtration rate increases to roughly 70% of what both kidneys handled together. In healthy kidney donors, that single remaining kidney’s filtration capacity rises by about 24% on average. For people who had a kidney removed because of disease, the compensation is more modest, around 13%, likely because the remaining kidney may already carry some burden.
This adaptation is why most people live completely normal lives with one kidney. In healthy donors, the risk of eventually developing kidney failure is real but extremely small. One large U.S. study tracking over 96,000 living donors found that 99 developed kidney failure, and a Norwegian study of 1,901 donors found 9 cases. While those numbers represent a several-fold increase over healthy non-donors in relative terms, the absolute risk remains very low because the baseline risk is close to zero. Notably, most of the donors who did develop kidney failure were blood relatives of their recipients, suggesting a shared genetic predisposition to kidney disease rather than a direct consequence of donation.
Multiple studies and a major meta-analysis have found no increase in heart disease risk or overall mortality for kidney donors compared to matched healthy individuals. Some research even shows lower mortality in donors, likely because donors are carefully screened and tend to be healthier than average to begin with.
Long-Term Diet and Lifestyle
Living with one kidney doesn’t require dramatic dietary changes, but some adjustments help protect the kidney you have. Most nephrologists recommend keeping protein intake moderate, around 0.8 to 1.0 grams per kilogram of body weight per day. For a 70 kg (154 lb) person, that works out to roughly 56 to 70 grams of protein daily, which is less than the typical Western diet but not severely restrictive.
Keeping sodium under 4 grams per day (about 1.5 teaspoons of table salt) reduces the workload on your remaining kidney and helps control blood pressure. Staying well hydrated matters too, though there is no need to force excessive water intake. Your doctor will likely monitor your kidney function with periodic blood tests, especially in the first year after surgery, to confirm your remaining kidney is adapting as expected.