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Kidney Surgery:
A guide to the procedure, risks and recovery

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1.What is a Kidney transplant?

Kidney transplant, also known as nephrectomy is a surgery is performed on your kidneys to remove all or part of your swollen kidneys, and treat a variety of conditions. The surgery is usually performed by a urologist or urologic surgeon.

Kidney transplant is required to treat conditions like kidney cancer, chronic kidney diseases, kidney stones removal, kidney infection, renal hypertension, traumatic kidney injury, kidney donation.

Your urologist may remove your swollen kidney through an open surgery or laparoscopically. Laparoscopic surgery means that smaller incisions are made and it takes a shorter time to recover from. Recovering from a nephrectomy can take several weeks, and may be very painful.

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2.Why is a kidney transplant performed?

To understand why kidney transplant is performed, it is important to understand how the kidneys function. Most people have two kidneys; these are fist-sized organs located near the back of the upper abdomen. Your kidneys are the organs that:

  • Filter waste, excess fluid and electrolytes from your blood
  • Produce urine
  • Maintain proper levels of minerals in your bloodstream
  • Produce hormones that help regulate your blood pressure

The most common reason a urologic surgeon performs a nephrectomy or kidney transplant, is to remove a tumour from the swollen kidney. These tumours are usually cancerous, but they can be noncancerous, or benign. There are many kidney conditions to be treated, hence there are many different types of kidney removal surgeries that can be done; the two most important are:

Damaged Kidney

When your kidney/s are damaged or swollen, you may need to have part or all of your kidney/s removed if they aren’t functioning properly. The main reasons for swollen kidney removal include damage or scarring. This may be caused due to disease, injury, or infection. Cancer is another reason why kidneys are removed.

Donating a Kidney

This is another reason why kidney transplant is performed. Very often, people may donate their healthy kidney to a person who is in need of a new kidney. The healthy donor kidney then replaces the recipient’s damaged kidney.

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3.What are the conditions that require a kidney transplant?

The conditions that require kidney transplant may include:

Kidney Cancer

Kidney cancer, also called renal cancer, is caused when kidney cells become malignant or cancerous, and grow out of control, forming a tumour and swell. Surgery is often the only recourse for those suffering from kidney cancer. There are very slim chances of surviving kidney cancer without surgery being performed. Even people whose cancer has spread to other organs may benefit from surgery to take out the kidney tumour. Very often, removal of the swollen kidney which is cancerous may enable people to live longer. In cases like these, a doctor may recommend surgery, even in cases where the cancer may have spread to areas beyond the kidney.

Chronic Kidney Diseases

The cause of chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you free from toxins. If kidney disease gets worse, your body’s waste can build to high levels in your blood and make you feel sick.

Kidney Stones Removal

A kidney stone is a rigid mass created from salts and minerals made up of calcium and uric acid present in the urine. Urine has various wastes dissolved in it. Excessive waste in very little liquid causes crystals to form. These crystals present in the kidney act as magnets, attracting other elements and uniting together to form a solid mass that normally gets larger, till such time it is excreted out of the body with urine. These chemicals usually pass away in the urine, directed by the body's master controller: the kidney. After formation, the hard mass may remain in the kidney or move down the person’s urinary tract, right into the ureter.

Kidney Infection

Your kidneys are part of your urinary tract, which makes urine and removes it from your body. The urinary tract is made up of your kidneys, ureters, bladder and urethra.

If any of these parts are exposed to bacteria, they can cause a urinary tract infection (UTI). Most often, it’s the bladder that gets infected. This is a sure sign of a kidney infection which needs to be treated as soon as possible.

Renal Hypertension

Renal hypertension which is also known as renovascular hypertension, is increased blood pressure which may be caused by kidney disease. Renal hypertension is also caused when the arteries that deliver blood to the kidneys become narrow. The arteries of one or both kidneys may be narrowed in this condition.

Traumatic Kidney Injury

Kidney or renal trauma occurs when a kidney is injured by an external force. The kidneys are protected by the back muscles and the rib cage. But injuries can happen as a result of:

  • Blunt trauma is a damaging condition that may be caused by impact from an object that doesn’t damage the skin.
  • Penetrating trauma is a damaging condition that may be caused by an object that pierces through the skin and thereafter enters the body.

Kidney Donation

Amongst the most common reasons for kidney donation to occur are emotional ties, as that between spouses or other family members. However, there are an increasing number of donors who are interested in donating to those in need in spite of having no familial ties.

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4.Types of Kidney transplant

Kidney transplant surgery

Kidney Removal Surgery:

Kidney removal, also called nephrectomy, is a type of surgery that removes the entire kidney or part of it. It may involve:

  • Part of one kidney being removed - partial nephrectomy
  • All of one kidney being removed - simple nephrectomy
  • Removal of a single kidney, including the surrounding fat, and adrenal gland – radical nephrectomy.

Simple nephrectomy or open kidney removal:

It requires you to be lying on your side. The surgeon will make an incision or cut up to 12 inches long. This will involve making an incision cut will be on your side, just below the ribs or right over your lowest ribs. Then the tube that takes urine from your kidneys to the bladder or ureter, and blood vessels, are surgically separated from the kidney. The kidney is then removed.

Partial Nephrectomy:

It requires just a part of the swollen kidney to be removed. The cut is then closed with stitches or staples.

Radical Nephrectomy or open kidney removal:

In this procedure, the surgeon will make a cut about 8 to 12 inches long. This surgical incision will be on the front side of the belly, just below the ribs. It may also be done through your side. The swollen kidney is then removed.

Laparoscopic kidney removal:

It is a procedure where the surgeon will make three or four small cuts, most often no more than 1 inch each, in your belly and side. The urologic surgeon will use microscopic probes and a camera to perform the surgery. Towards the end of the procedure, the surgeon will make one of the cuts larger about 4 inches, to take out the swollen kidney.

Surgery for Kidney Cancer:

Your surgeon will evaluate your condition based on factors such as the size and location of the tumour. Depending on your situation, he may use a standard open surgical approach or a minimally invasive technique using tools, such as laparoscopes, that can remove tissue.

To remove the entire swollen kidney, a procedure called Radical Nephrectomy is used. The presence of large tumours may force a kidney specialist hospital to recommend this option.

Kidney transplant:

Kidney transplant surgery normally lasts about three to four hours. During surgery, the transplanted kidney is placed in the pelvis near one of your hip bones. The surgeon connects the blood vessels from the transplanted kidney to the blood vessels in the pelvis.

The ureter (urine drainage tube) from the transplanted kidney is connected to your bladder so urine can be excreted. A stent, which is actually a flexible, narrow tube, is inserted into the ureter, and passes into the bladder to keep an open connection. The stent will then be extracted around six weeks after surgery, using a surgical procedure called a cystoscopy.

Surgery for Kidney Stones:

There are five types of surgery procedures for removing kidney stones.

  • Extracorporeal Shockwave Lithotripsy Procedure (ESWL) – This is a procedure in which a non-electrical shock wave is passed through your body to the area that is infected, to impact the stone until it reduces to sand-like consistency, and passes on.
  • Percutaneous Nephrolithotomy (PNL) – When the kidney stone is situated in a location that is difficult to reach by non-electrical shock waves, this procedure comprises making a tunnel to the kidney through an opening at the back; the location of the stone is determined and extracted by a nephroscope.
  • Ureteroscopic Stone Removal – In this procedure, an ureteroscope is passed into the ureter and the stones are shattered using a shockwave producing equipment or removed using a cage-like device.
  • Open Surgery – here the area that is infected is cut open and kidney stones are completely removed.
  • Coagulum Pyeloloithotomy – This is the least invasive procedure. It uses antibiotics to remove the kidney stones.

Kidney Cyst surgery:

A kidney cyst is a fluid-filled sac that develops on one or both of the kidneys. These cysts are round, thin walled and can range in size from microscopic to around 0.5 inch in diameter. They may be associated with a serious condition, but in most cases, they are harmless and referred to as simple kidney cysts.

If the kidney swells or becomes large enough to cause pain, discomfort, or high blood pressure, it may need to be surgically removed. Some approaches used to remove a cyst are described below.

Retrograde Intrarenal Surgery:

A procedure is the go to choice for cases where a cyst can be accessed from the part of the kidney basin involved in draining. A small telescope is passed into the ureter to the kidney, where a laser is used to make a cut in the cyst and open it so that it can be drained.

Percutaneous Kidney transplant:

Employed in case of larger cysts that have developed in the posterior of the kidney. This minimally invasive technique enables the surgeon to perform endoscopic surgery on the swollen kidney using a small opening called a tract. A procedure called a tract is created by making a tiny cut in the skin and tissue, leading straight into the kidney.

To cover the distance between your kidney and skin, a sleeve is placed into the organ. Endoscopic instruments are then guided through the sleeve and into the kidney so that the cyst can be opened and a large portion of the wall removed under X-ray guidance.

Laparoscopy and Removal of the Cyst:

It is usually performed when a patient has multiple cysts or a very large cyst. Laparoscopy and cyst removal is the most suitable kidney specialist hospital for a genetic condition called polycystic kidney disease (PKD).

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5.Are you the right candidate for kidney surgery?

Kidney transplant surgery

Many people are of the opinion that a successful kidney transplant is the gateway to a better quality of life than dialysis. To be considered for one, you must be evaluated at a transplant centre or kidney specialist hospital. This is carried out to ensure that a kidney transplant is truly the very best choice for you. The evaluation will be very thorough, and may take several months to complete. You will meet with members of the transplant team, which may include a transplant surgeon, nephrologist, nurse coordinator and dietitian. Your transplant team will need to know a lot about you to help them—and you—decide if a transplant is right for you.

Your evaluation

Most kidney specialist hospitals or centres have a coordinator who will speak to you over the phone and start the process. The coordinator will get basic information and then send you a questionnaire to complete.

The next step is an initial visit to a kidney specialist hospital. You will meet with several people at the transplant centre. The team will then speak about the transplant process with you, and examine your physical, psychosocial, and financial needs. You can best help with the process by getting all your testing done as quickly as possible.

At the kidney specialist hospital or evaluation centre you can expect to have:

  • A medical and surgical history
  • A physical exam
  • A psychosocial assessment
  • Compatibility tests

After the follow-up evaluation is complete, the transplant team at the kidney specialist hospital will meet to discuss your results. You will not be present for this meeting. The person co-ordinating the transplant will contact you about the team’s recommendation on a kidney transplant and the next steps to be taken.

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6.How do I prepare for swollen kidney transplant?

You'll receive instructions at the kidney specialist hospital about what to do the day before and the day of your surgery. Make a note of any questions you might have:

  • When do I need to begin fasting?
  • Can I take my prescription medications?
  • If the answer to the above is yes, how soon before the surgery can I take a dose?
  • What non-prescription medications should I avoid?
  • When do I need to arrive at the hospital?

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7.Complications and risks that may arise

Recovery time after the procedure and the length of your kidney specialist hospital stay depends on your overall health and the type of nephrectomy performed. You can expect to receive thorough instructions before leaving the hospital, on issues like restrictions to your diet and other activities. You may be advised as to when you can begin light, everyday activities as your ability permits. You'll also need to keep away from strenuous activity, like heavy lifting for several weeks.

Kidney transplant surgery is a procedure that bears the risk of the following complications:

  • Blood clots and bleeding
  • Leakages from or blockage of the ureter, that connects the kidney to the bladder
  • Infection
  • Failure or rejection of the donated kidney
  • Any infection or cancer that could be transmitted via the donated kidney

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8.Precautions to take after a kidney transplant

Kidney disease diagnosis

After your kidney transplant, you can expect to:

  • Spend several days to a week in the kidney specialist hospital:
  • Doctors and nurses will be monitoring your condition in the hospital, to watch for any sign of complications. Your new treated kidney will make urine like your own kidneys did when they were healthy. You can expect some degree of soreness or pain around the surgery site during your healing process. Many kidney transplant recipients return to work and resume their normal activities within eight to ten weeks after the transplant.

  • Have frequent check-ups as you continue recovering:
  • After you leave the kidney specialist hospital, close monitoring is necessary for a few weeks to check how well your new kidney is working after kidney specialist hospital or transplant, and to make sure your body is not rejecting it.

  • Take medications the rest of your life:
  • You will need to be taking a number of medications after your kidney transplant. A category of drugs called immunosuppressants or anti-rejection medications, will help to keep your immune system from attacking and rejecting your newly transplanted kidney.

Diet and Nutrition

After your kidney transplant at the kidney specialist hospital, you may need to adjust your diet to keep your new kidney healthy and functioning well. You will probably have fewer dietary concerns, as compared to the time you were receiving dialysis before your transplant, but you still may need to make some diet changes.

Exercise

Once you recover from your transplant surgery, exercise and physical activity should be a regular part of your life to continue improving your overall physical and mental health. After your transplant, doing regular exercise helps boost your energy levels and increase your strength.

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9.Kidney transplant FAQs: All your concerns addressed

Q.  What is a kidney transplant?

  1. Kidney transplant, also known as nephrectomy is a surgery is performed on your kidneys to remove all or part of your swollen kidneys, and treat a variety of conditions. The surgery is usually performed by a urologist.

Q.   Why is a kidney transplant performed?

  1. The two most important reasons are:
  1. Damaged kidney
  2. When your kidney/s are damaged, you may need to have part or all of your kidney/s removed if they aren’t functioning properly.
  3. Donating a Kidney
  4. This is another reason why surgery is performed on swollen kidneys. Sometimes a person will choose to donate their healthy kidney to a person who needs a new kidney. The healthy donor kidney then replaces the recipient’s damaged kidney, in a surgery called kidney transplants.

Q.  What are the various types of kidney surgeries?

  1. Kidney Removal Surgery
  1. Kidney removal or nephrectomy, is a surgery that is performed to remove the entire kidney or part of it. It may involve:
  • Part of one kidney being removed
  • All of one kidney being removed
  • Removal of one entire kidney

Q.   Surgery for Kidney Cancer

  1. The surgeon at your kidney specialist hospital will evaluate your condition based on factors such as the size and location of the tumour.

Q.  Kidney Transplant

  1. Kidney transplant surgery normally lasts about three to four hours. During surgery, the transplanted kidney is placed in the pelvis near one of your hip bones. The surgeon connects the blood vessels from the transplanted kidney to the blood vessels in the pelvis.
  2. The ureter or urine drainage tube from the transplanted kidney is connected to your bladder so urine can be excreted. A stent is a flexible, narrow tube that is inserted into the ureter, and enters the bladder in order to keep an open connection.

Q.  How do I take care of my kidneys?

  1. To preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity and attend regular check-ups to monitor your kidney health. If you are awaiting a donated kidney or a transplant surgery is scheduled, you need to intentional and work towards staying healthy. Be as healthy and as active as you are capable of; this will better prepare you for the transplant surgery. It will certainly help to speed up your recovery from the surgery.