Survivorship: Health Concerns After Nephrectomy
Treatment for kidney cancer often involves surgical removal of all or part of the kidney (called nephrectomy). The type of surgery done depends on the stage of cancer and your health. The two types of nephrectomy used are radical nephrectomy and partial nephrectomy. A radical nephrectomy is the removal of one entire kidney, adrenal gland, nearby lymph nodes, and, in some cases, nearby veins. A partial nephrectomy is the removal of only part of one kidney.
Chronic Renal Insufficiency
There are not many complications from these surgeries since our bodies can function with only one kidney. The development of chronic renal insufficiency (CRI) is an uncommon, but very serious side effect. It can progress to complete kidney failure requiring dialysis. CRI can cause hypertension (high blood pressure), anemia, neuropathy (numbness or tingling in fingers/toes) and a higher risk of heart disease. In a partial nephrectomy (also called nephron-sparing surgery), the tumor is removed, and the normal functioning kidney is left intact. This appears to greatly reduce the risk of CRI, but it is not an option for all patients.
The risk of kidney problems is higher if you have also had radiation to the kidney/abdomen or chemotherapy that can cause kidney damage (cisplatin, ifosfamide, and methotrexate). Other things that increase the risk of kidney problems include diabetes, high blood pressure, smoking, and being over 60 years of age.
Tips For Keeping Your Kidney Healthy
You should have an annual physical by your healthcare provider. They should check that your blood pressure and blood sugar are normal (or well-controlled on medication). You should not smoke, as this can damage the remaining kidney. If you do smoke, talk to your provider about a plan to quit. Signs of kidney damage include poor kidney function found with blood tests, protein in the urine found with urine tests, or hypertension (high blood pressure).
If you have only one kidney, you need to be careful to avoid damage to this kidney. This includes wearing seatbelts to minimize the risk of damage in a car accident. In the past, survivors were advised to avoid contact sports, but research in pediatric cancer survivors has found the risk of damage to the remaining kidney related to a sports injury to be very low.
In addition, any abdominal surgery can put you at risk for bowel obstructions (due to scarring) and hernia (due to cutting the abdominal muscle). Radiation therapy to the abdomen (belly area) and pelvis can increase the risk of these issues.
References
Grinsell, M. M., Showalter, S., Gordon, K. A., & Norwood, V. F. (2006). Single kidney and sports participation: perception versus reality. Pediatrics, 118(3), 1019-1027.
Kawamura, N., Yokoyama, M., Fujii, Y., Ishioka, J., Numao, N., Matsuoka, Y., ... & Morimoto, S. (2016). Recovery of renal function after radical nephrectomy and risk factors for postoperative severe renal impairment: a Japanese multicenter longitudinal study. International Journal of Urology, 23(3), 219-223.
Malcolm, J. B., Bagrodia, A., Derweesh, I. H., Mehrazin, R., DiBlasio, C. J., Wake, R. W., ... & Patterson, A. L. (2009). Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy. BJU international, 104(4), 476-481.
Okada, M., Hockenberry, M. J., Koh, C. J., Meeske, K. A., Rangan, K. E., Rodgers, C., ... & Freyer, D. R. (2016). Reconsidering Physical Activity Restrictions for Mononephric Survivors of Childhood Cancer: A Report From the Children’s Oncology Group. Journal of Pediatric Oncology Nursing, 33(4), 306-313.