Nephrectomy in Dogs

Nephrectomy, surgical removal of the kidney and its associated ureter, is a surgical procedure used to treat irreversible conditions of the kidney and ureter. It is a relatively rare procedure in dogs, as common as the conditions it is used to treat. Conditions treated by nephrectomy include trauma to the kidney and/or ureter, cancer, ureteral abnormalities, and persistent infection. Depending on the condition, nephrectomy can be a primary intervention in cases such as kidney cancer that has not metastasized or a measure for more advanced diseases such as persistent kidney infection. Your veterinarian will diagnose the condition that needs to be treated and then either perform the procedure or refer your dog to a boarded veterinary surgeon.

Prior to the procedure, there are several steps that should be taken. The health of the kidney that is not being removed should be assessed using glomerular filtration rate (GFR) if possible. If cancer is suspected, a full staging should be provided to determine the extent the cancer has spread throughout the body. Any hydration or electrolyte abnormalities should be corrected prior to the procedure as well.

Depending on the condition being treated, this procedure will be done immediately in cases such as acute trauma or after several different hospital visits as in the case of a cancer diagnosis that requires staging.

General anesthesia is needed for this procedure as it is an invasive surgery. Most anesthesia protocols are safe for this procedure although care should be taken to select anesthetic drugs that are minimally toxic to the kidneys.

For the procedure, the dog is placed on its back under general anesthesia. An incision is made on the abdomen from just under the sternum to the pubic bone. The kidney is visualized after the rest of the abdomen is explored for any abnormalities. The kidney is removed from its parenchyma (a thin tissue that separates the kidney from the rest of the abdomen) and the renal artery and vein identified. The renal artery and vein are each tied off and cut and then the ureter associated with the kidney is tied off and cut. The kidney and ureter are then removed. After checking for signs of bleeding, the patient is closed and recovery can begin.

Nephrectomy is an effective treatment in the goal of alleviating irreversible kidney and ureter conditions in dogs. The effects of nephrectomy are permanent and irreversible. Other treatments that may be used instead of nephrectomy include partial nephrectomy and ureteroneocystostomy (implantation of a resected ureter into the bladder). Partial nephrectomy may spare some kidney function so that the other kidney does not have the strain of providing all the renal function for the animal. Unfortunately, partial nephrectomy increases the risk of persistent bleeding after surgery and it is often more risky than removing the entire kidney. Ureteroneocystostomy may be indicated for trauma to the ureter; however, this procedure does not have as good of patient outcome as nephrectomy.

After surgery, your dog will be placed on pain medication to alleviate any immediate postoperative pain and kept on a pain medication for the first few days after surgery. The skin incision should heal 14 days after the procedure, after which time a visit to the vet for suture removal is needed. During the time between the operation and suture removal it is important to monitor the incision site for any signs of infection such as swelling, redness and discharge. For all nephrectomy patients, it will be important for kidney function and signs of postoperative complications to be evaluated. The most common postoperative complications of nephrectomy are bleeding and urine leaking into the abdomen. These complications can be caught through physical exam and bloodwork.

If cancer was the reason for the nephrectomy, follow-up appointments will include recommended chemotherapy and continued monitoring for the spread of disease including imaging of the chest and abdomen using ultrasound and x-ray.

The cost of nephrectomy can range from $900-$1,500. The cost of the procedure and related treatment varies, depending on the clinic and severity/complexity of the condition being treated. Requirements for medication, hospitalization, preoperative testing, postoperative monitoring, and other services may influence the cost of treatment.

Nephrectomy can alleviate symptoms associated with damage to the kidney and ureter and extend survival time when used to remove a cancerous kidney. The main risks associated with nephrectomy are bleeding and leakage of urine into the abdomen. Long term, it is important to ensure that the remaining kidney stay healthy for as long as possible.

Prevention of conditions such as cancer and trauma that may lead to nephrectomy is difficult. Most often, it is best to ensure that the kidneys are as healthy as possible so that the remaining kidney is functioning well and your pet is a good candidate for nephrectomy. Steps to take to ensure your pet’s kidneys stay healthy are:

• Providing ample water: Hydration is key to preventing kidney disease
• Balanced diet: A special urinary diet is not needed

For pets that have persistent kidney stones that may lead to infection and eventual nephrectomy, there are additional steps that can be taken.

• Kidney stone diet
• Medical management
• Monitoring your pet for signs of urinary tract infection such as straining to urinate, blood in urine, and accidents in the house