Nephrectomy

Nephrectomy is considered when one kidney is beyond salvage and its presence is causing ongoing problems. Common reasons include:

• A kidney tumor (such as renal carcinoma or nephroblastoma) that is confined to one side
• Severe chronic pyelonephritis (deep kidney infection) unresponsive to long-term antibiotics
• Hydronephrosis (fluid-filled, non-functional kidney) caused by an irreversible blockage
• Significant trauma — rupture or avulsion — that cannot be repaired
• Severe kidney cysts replacing functional tissue

Removal is only recommended when the opposite kidney has been confirmed healthy enough to compensate, based on bloodwork, urine concentration, and imaging.

Nephrectomy is performed under general anesthesia with full cardiac and respiratory monitoring. The procedure steps typically include:

• An abdominal incision gives access to the retroperitoneal space where the kidneys sit
• The blood vessels supplying the kidney (renal artery and vein) are carefully isolated and ligated (tied off)
• The ureter — the tube connecting the kidney to the bladder — is also tied off and divided
• The kidney is fully freed from its surrounding fat and connective tissue and removed
• The abdomen is inspected and closed in layers

In select cases, a minimally invasive (laparoscopic) approach may be discussed depending on the patient's size, body condition, and the nature of the disease.

Thorough pre-operative evaluation is especially important for nephrectomy because the remaining kidney must carry the full burden of filtration after surgery. Preparation includes:

• Complete bloodwork and urinalysis to assess kidney function values (BUN, creatinine, SDMA) and urine concentrating ability
• Abdominal ultrasound or CT scan to assess both kidneys and confirm the problem is limited to one side
• Chest X-rays if cancer is suspected, to look for spread to the lungs
• Blood pressure measurement, as kidney disease often causes hypertension
• Fasting from food the night before surgery (water is generally allowed until a few hours prior)

If your pet's remaining kidney function is borderline, the surgical team may recommend stabilization with intravenous fluids before proceeding.

Most dogs and cats are hospitalized for one to two days after nephrectomy for IV fluid support, pain management, and monitoring. At-home recovery typically unfolds as follows:

• Days 1–7: restricted activity, incision monitoring, pain medications and anti-nausea drugs as needed
• Weeks 1–2: short, leashed outdoor time only; no running or jumping
• 2–3 weeks: suture or staple removal at a recheck appointment
• 4–6 weeks: bloodwork recheck to verify kidney values are stable on a single kidney

Long-term, pets living with one kidney benefit from a kidney-friendly diet, careful monitoring of blood pressure and kidney values at annual or semi-annual wellness visits, and avoiding medications that can strain the kidneys.

Nephrectomy carries the general risks of any major abdominal surgery — anesthetic complications, bleeding, and infection — all of which the team monitors closely. The most important specific consideration is the remaining kidney: if it was already mildly compromised before surgery, the added workload may accelerate kidney disease over time. This is why pre-operative testing is so thorough. In the majority of patients with a healthy contralateral kidney, the remaining organ compensates well and kidney values remain acceptable. For cancer cases, prognosis also depends on the tumor type and whether it has spread, which your veterinary team will discuss with you in detail.