Definition:
- Nephrectomy is the surgical removal of all or part of a kidney.
- Performed in oncology primarily for renal tumors such as Wilms tumor, renal cell carcinoma, or other renal malignancies.
Types of Nephrectomy
| Type | Description | Indications / Notes |
|---|---|---|
| Radical nephrectomy | Entire kidney + adrenal gland + surrounding fat + regional lymph nodes | Standard for large or high-stage renal tumors |
| Partial / Nephron-sparing nephrectomy | Only tumor + small margin of healthy tissue | Used in bilateral tumors, solitary kidney, or pediatric Wilms tumor |
| Laparoscopic / Robotic nephrectomy | Minimally invasive | Faster recovery, less blood loss, used for selected patients |
Clinical Considerations in Oncology
- Pre-operative
- Renal function assessment (serum creatinine, eGFR, electrolytes)
- Imaging studies for staging
- Blood pressure control, coagulopathy assessment
- Post-operative
- Monitor renal function (especially if contralateral kidney is impaired)
- Monitor fluid and electrolyte balance
- Pain management
- Assess for bleeding or infection
Pharmacist Considerations
- Drug dosing adjustments after nephrectomy:
- Drugs excreted renally (e.g., cisplatin, methotrexate, ifosfamide, aminoglycosides) may require dose modification
- Hydration protocols with nephrotoxic chemotherapy should consider remaining renal function
- Analgesics: avoid nephrotoxic NSAIDs if kidney function is compromised
- Long-term monitoring: hypertension, CKD risk, and potential impact on other therapies
High-Yield Pharmacist Pearls
- Partial nephrectomy preferred in pediatric Wilms tumor for bilateral disease or solitary kidney
- Renal function monitoring is critical for subsequent chemotherapy dosing
- Drug clearance may be reduced, especially for nephrotoxic or renally excreted agents
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