A nephrectomy is surgery to remove all or part of a kidney. It’s most commonly performed to treat kidney cancer, but it’s also used for severe kidney damage, recurring infections, and living organ donation. Most people recover within three to six weeks and live full, healthy lives with one functioning kidney.
Types of Nephrectomy
There are three main types, and the distinction comes down to how much tissue the surgeon removes.
- Partial nephrectomy: Only the tumor or diseased portion of the kidney is removed, leaving the rest intact. This is preferred when the tumor is small enough and the surrounding tissue is healthy, because it preserves more kidney function.
- Radical nephrectomy: The entire kidney is removed, often along with surrounding fatty tissue and nearby lymph nodes. This is the standard approach for larger or more aggressive kidney cancers.
- Simple nephrectomy: The kidney alone is removed without surrounding tissue. This is typically used for non-cancerous conditions like a severely damaged or nonfunctional kidney, or when a living donor gives a kidney for transplant.
Why It’s Done
The most common reason is a kidney tumor. The majority of kidney cancers in adults are renal cell carcinoma, which starts in the cells lining the tiny tubes inside the kidney. In children, kidney tumors are rare, but when they occur they tend to be a type called Wilms tumor.
Not every tumor is cancerous. Some are benign growths that still need removal because of their size or location. Beyond tumors, a nephrectomy may be recommended if you have recurrent kidney infections that keep coming back despite treatment, a kidney that has stopped working and is causing symptoms or complications, polycystic kidney disease, or serious kidney injury. A nonfunctional kidney that isn’t causing problems can often stay in place.
Living kidney donation is another major reason. A healthy person undergoes a simple nephrectomy so their kidney can be transplanted into someone with kidney failure.
Open, Laparoscopic, and Robotic Surgery
The operation can be done three ways, and the choice depends on tumor size, complexity, and the patient’s overall health.
Open surgery uses a single larger incision and gives the surgeon direct access to the kidney. It’s typically reserved for larger or more complex tumors, cases where cancer has spread into nearby blood vessels, or patients with significant other health conditions. The trade-off is a longer hospital stay: a median of four days, with many patients staying between three and seven.
Laparoscopic surgery uses several small incisions and a camera to guide the procedure. Robotic-assisted surgery is similar but adds a robotic system that gives the surgeon more precise control and better visualization. Both minimally invasive approaches result in a median hospital stay of about two days and roughly 20% shorter stays compared to open surgery. Robotic surgery edges out laparoscopic with about 5% shorter stays on average, though it tends to cost more.
For most patients, the surgeon will recommend the least invasive option that still allows a complete and safe removal.
What Recovery Looks Like
Full recovery from a nephrectomy generally takes three to six weeks. Most people can return to their regular daily activities within four to six weeks, though the timeline varies depending on which surgical approach was used. Minimally invasive procedures have shorter recovery periods than open surgery.
In the weeks after surgery, you’ll need to avoid lifting anything heavier than 10 pounds (about 4.5 kilograms) until your surgeon clears you. That means no heavy exercise, weightlifting, or any activity that makes you strain or breathe hard. Your surgeon will let you know at a follow-up appointment when it’s safe to resume these activities.
Risks and Complications
Like any major surgery, nephrectomy carries risks. In a large study of radical nephrectomy patients, about 19% experienced at least one complication in the early postoperative period. The most common categories were gastrointestinal issues (such as slow return of bowel function), bleeding requiring transfusion, and pulmonary problems. Infection and cardiac complications each accounted for roughly 11% of reported complications.
Serious complications like sepsis or the need for a second operation are uncommon. Minimally invasive approaches generally carry lower complication rates than open surgery, which is one reason surgeons favor them when feasible.
Living With One Kidney
Your remaining kidney compensates surprisingly well. After one kidney is removed, the other kidney increases its filtering capacity within the first one to six months. Studies show the remaining kidney typically gains an additional 11 or more units of filtering capacity beyond the 50% baseline you’d expect from losing one kidney. In practical terms, your single kidney handles most of the workload that two kidneys used to share.
That said, protecting your remaining kidney becomes a long-term priority. Current guidelines for people with a single kidney recommend keeping daily protein intake moderate, avoiding more than about 1 gram of protein per kilogram of body weight per day. Sodium should stay under 4 grams daily. A diet rich in plant-based fiber supports kidney health, and maintaining a healthy body weight (a BMI under 30 for most people) reduces the strain on your remaining kidney over time.
Staying well hydrated, managing blood pressure, and having your kidney function checked periodically are the practical cornerstones of living well with one kidney. Most people who follow these guidelines maintain strong kidney function for decades.