Nephrectomy Child - Kidney Removal Surgery Child
Nephrectomy in a child removes all or part of a kidney that no longer works and causes infections, pain or high blood pressure, or a kidney with a Wilms tumor. Most benign operations are done by keyhole surgery with one to two days in hospital, and partial nephrectomy keeps healthy kidney tissue whenever possible. At Biruni Hospital in Istanbul, our pediatric urology team plans each operation, and our nephrologists follow children with one kidney for life.
About This Department
Children live well with one healthy kidney. Nephrectomy removes a kidney that harms more than it helps, or one that holds a tumor.
Nephrectomy in a child removes all or part of a kidney. For benign conditions the kidney has stopped working and causes infections, pain or high blood pressure, from blockage, severe reflux or a malformation present from birth, and for cancer the operation removes a Wilms tumor, the most common kidney cancer of childhood. Keyhole surgery has become the standard for benign kidneys. In a London series of 213 children, complications during surgery were more frequent with open operations, and no retroperitoneoscopic operation needed conversion to open surgery (Mosa and colleagues, Journal of Laparoendoscopic and Advanced Surgical Techniques, 2021). For Wilms tumor, a 2025 meta-analysis found similar tumor spill, recurrence and survival after keyhole and open nephrectomy in selected children. Keyhole surgery sampled fewer lymph nodes (Pio and colleagues, Pediatric Surgery International, 2025). This page explains reasons for nephrectomy, tests, partial nephrectomy, keyhole and open techniques, Wilms tumor surgery, recovery, life with one kidney, and how families from abroad arrange kidney removal surgery for a child at Biruni Hospital in Istanbul.
What nephrectomy means
| Operation | What is removed | Common reason |
|---|---|---|
| Simple nephrectomy | The kidney | Non-working kidney |
| Nephroureterectomy | Kidney and its ureter | Severe reflux, megaureter |
| Partial or heminephrectomy | Part of the kidney | Duplex kidney, some tumors |
| Radical nephrectomy | Kidney, fat, lymph nodes | Wilms tumor |
Removal is the last step. Before any decision we measure how much the kidney still contributes and whether surgery to repair it would help more.
| Specialist | Role | When |
|---|---|---|
| Pediatric urologist or surgeon | Plans and performs the operation | Throughout |
| Pediatric nephrologist | Kidney function and blood pressure | Before and for years after |
| Pediatric radiologist | Ultrasound, MRI, nuclear scans | Before surgery |
Reasons to remove a kidney
| Condition | What happens | When surgery helps |
|---|---|---|
| Long-standing blockage | Kidney damaged by obstruction at the pelvis or ureter | Under 10 percent function, infections or pain |
| Severe reflux | Scarred kidney, repeated fever infections | Non-working kidney with infections |
| Multicystic dysplastic kidney | Kidney of cysts with no function | Growth, high blood pressure, rarely |
| Renovascular hypertension | Small kidney driving blood pressure up | Medicines fail |
Before kidney transplant
| Reason | Example | Approach |
|---|---|---|
| Stones | Kidney destroyed by stones and infection | Keyhole nephrectomy |
| Injury | Severe trauma with bleeding | Repair first, removal if needed |
| Tumor | Wilms and other kidney tumors | Radical or partial nephrectomy |
Does a multicystic dysplastic kidney always need removal?
Watching first
Many non-working kidneys cause no symptoms, and we follow them with ultrasound and blood pressure checks instead of removing them.
Tests before the decision
Measuring function
The DMSA scan shows how much each kidney contributes. A kidney giving under ten percent of total function rarely recovers.
| Test | What it shows | Note |
|---|---|---|
| Ultrasound | Size, cysts, swelling, the other kidney | First test |
| DMSA or MAG3 scan | Split function, drainage | Nuclear medicine |
| Voiding cystourethrogram | Reflux into the ureters | When reflux suspected |
| MRI or CT | Tumors, anatomy, vessels | For tumors and complex cases |
The other kidney gets the same careful look. Removal is planned only when it is healthy.
Family discussion
Partial nephrectomy
Can the remaining part of the kidney be harmed?
Kidneys we try to keep
Removal cannot be reversed.
Before recommending nephrectomy we look for every way to save kidney tissue, by repairing a blockage with pyeloplasty, treating reflux with an endoscopic injection or reimplantation, removing only the non-working part of a duplex kidney, or, in Wilms tumor that affects both kidneys or a single kidney, removing the tumor and leaving the rest, because every nephron matters across a lifetime and a child with two working kidneys has a larger reserve for illness, injury or pregnancy later in life. When function has gone and the kidney causes harm, we recommend removal.
We explain both paths and give the family time.
Keyhole or open surgery
| Approach | Conversion to open | Complications |
|---|---|---|
| Retroperitoneoscopic, from the back | None | Rare |
| Transperitoneal laparoscopic | 5.4 percent | Rare |
| Open | Not applicable | More frequent during surgery |
| Situation | Preferred route | Reason |
|---|---|---|
| Non-working kidney, no reflux | Retroperitoneoscopic | Quick recovery |
| Reflux into the ureter | Transperitoneal laparoscopic | Removes the full ureter |
| Large tumor, earlier surgery | Open | Safety and complete removal |
Children go home one to two days after keyhole nephrectomy for benign disease.
Wilms tumor
Wilms tumor, also called nephroblastoma, is cured in more than nine of ten children with surgery and chemotherapy, and in some with radiotherapy.
| Approach | First step | Used in |
|---|---|---|
| SIOP | Four weeks of chemotherapy before surgery | Europe and most of the world |
| COG | Surgery first in most children | North America |
| Both | Chemotherapy after surgery by stage and histology | Worldwide |
Chemotherapy before surgery
Children with syndromes linked to Wilms tumor, such as WAGR, Denys-Drash or Beckwith-Wiedemann, need ultrasound screening every three months during early childhood.
The Wilms tumor operation
| Outcome | Keyhole | Open |
|---|---|---|
| Tumor spill and positive margins | Similar | Similar |
| Recurrence and survival | Similar | Similar |
| Lymph nodes sampled | Three fewer | More |
| Hospital stay | About one day shorter | Longer |
Will our child need radiotherapy?
Saving part of a kidney with a tumor
| Situation | Choice | Note |
|---|---|---|
| Tumors in both kidneys | Partial nephrectomy on both sides when possible | After six to twelve weeks of chemotherapy |
| Tumor in a single kidney | Partial nephrectomy | Avoids dialysis |
| Small polar tumor, one side | Selected cases | Needs clear margins |
Partial nephrectomy for a one-sided tumor with a normal other kidney is chosen only when the tumor is small, at one pole, and complete removal is certain.
The day of surgery
| Step | Timing | Note |
|---|---|---|
| Arrival and checks | Morning | Numbing cream |
| Anesthesia | Parent present at induction | General anesthesia, local block |
| Surgery | One to two hours keyhole, two to four open | Longer for tumors |
| Recovery | One to two hours | Then the ward or intensive care |
Fasting follows standard rules, solids six hours, breast milk four hours and clear fluids one hour before anesthesia.
Recovery at home
- Keyhole surgery for benign disease, back to nursery or school in one week.
- Open surgery, two to three weeks off school.
- No contact sport or climbing for four to six weeks after open surgery.
The scars are small after keyhole surgery and fade within a year.
| Sign | Possible cause | Action |
|---|---|---|
| Fever over 38.5 degrees | Infection | Call the same day |
| Little urine, swelling | Kidney strain or dehydration | Call at once |
| Wound redness or discharge | Wound infection | Send a photograph |
| Severe belly pain or vomiting | Bowel problem after surgery | Call at once |
Life with one kidney
Everyday advice
| Area | Advice | Reason |
|---|---|---|
| Medicines | Avoid regular ibuprofen and similar drugs | They strain the kidney |
| Salt and weight | Normal diet, low salt, healthy weight | Blood pressure |
| Sport | Most sports are fine, discuss collision sports | Injury is rare |
Talking with your child
Children notice scars and ask questions.
Simple words help at each age, a doctor took away a kidney that was making you ill and the other one works for both, and older children with one kidney can carry a small card or a note on their phone so that any doctor treating them later knows, while teenagers learn the reasons for yearly checks and take part in the visits themselves. Our psychologists support children treated for Wilms tumor and their brothers and sisters.
Pride in a scar helps too.
For families from abroad
For Wilms tumor, we coordinate chemotherapy before surgery either in Istanbul or with your home team using the same protocol.
Children in Wilms treatment may stay for the full course of chemotherapy, or return home between phases.
Cost
| Item | Included | Priced separately |
|---|---|---|
| Surgery | Surgeon, anesthesia, operating room, pathology | Second operations |
| Hospital | Ward stay as planned, intensive care when planned | Extra days |
| Aftercare | Medicines at discharge, video follow-up | Chemotherapy, radiotherapy |
What changes the price
Keyhole surgery for a benign kidney costs less than open surgery for a tumor.
| Factor | Effect | Example |
|---|---|---|
| Diagnosis | Benign or tumor | Wilms needs staging and chemotherapy |
| Approach | Keyhole or open | Large tumors are removed open |
| Extra tests | Nuclear scans, MRI | When not done before travel |
Quotes for tumors
For Wilms tumor, the quote follows the plan the tumor board proposes and lists surgery, chemotherapy and any radiotherapy separately.
References
- Mosa H, Giannettoni A, Patil K, et al. Pediatric nephrectomy, comparison of perioperative outcomes of three different minimally invasive and open approaches. J Laparoendosc Adv Surg Tech A. 2021;31(12):1466-1470.
- Pio L, Bruno T, Godzinski J, et al. Comparison of open and minimally invasive nephrectomy for Wilms tumor, a systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology. Pediatr Surg Int. 2025;41(1):117.
- Malek MM, Behr CA, Aldrink JH, et al. Minimally invasive surgery for pediatric renal tumors, a systematic review by the APSA Cancer Committee. J Pediatr Surg. 2020;55(11):2251-2259.
- Li S, Wang J, Li M, et al. Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor, a systematic review and meta-analysis. Pediatr Surg Int. 2024;40(1):29.
- Mavinkurve-Groothuis AMC, van de Kracht F, Westland R, et al. Long-term follow-up of blood pressure and glomerular filtration rate in patients with a solitary functioning kidney, a comparison between Wilms tumor survivors and nephrectomy for other reasons. Pediatr Nephrol. 2016;31(3):435-441.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Emel TORUN, Pediatrics.
Medically reviewed by
Prof. Dr. Emel TORUN
Pediatrics
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