Surgery on the kidney is done for many reasons, such as transplants, removal of the kidney (nephrectomy) and on the adrenal glands situated on the kidney. Surgery always has risks of complications due to its invasive nature, and the kidney offers unique sets of complications after the operation.
Usually, patients have a very minimal risk of death when undergoing kidney surgery. However, those with atherosclerotic disease of the renal arteries have a much higher chance of death. Screening of the patients preoperatively is done to identify those with increased risk and preoperative treatment to reduce surgical risk.
High blood pressure, or hypertension, often occurs in patients after kidney surgery. It can be due to a variety of reasons, such as kidney damage and poorly controlled pain. If not properly controlled, it can cause bleeding from fresh surgical sutures.
Increased bleeding after surgery can occur in almost all surgical procedures, and its occurrence in kidney surgery is usually due to poor technique. It can appear early after surgery, and also weeks to months later. In the latter case, it can be attributed to infection of sutures or prosthetic grafts eroding into organs.
Renal Artery Thrombosis
This refers to clots that can form and obstruct the renal artery. It generally occurs within the first few days after surgery. Decreased blood flow after surgery, decreased blood volume and the patient being predisposed to clots are risk factors for development of this complication.
Stenosis of the Renal Artery
This is typically a late complication that can occur from weeks to years after surgery. Risk factors for this are similar to renal artery thrombosis. This complication describes when the lumen of the artery is narrowed, which decreases blood flow through the artery.
Renal Artery Aneurysm
This complication refers to the development of an area of weakness in the renal artery after surgery that pouches out and is at risk of rupture. This usually develops when arterial graft tissue is used during surgery that's not strong enough to handle the blood pressures that normally flow through blood vessels.
During renal surgery, the abdominal aorta can be clamped and then unclamped to make surgery possible in that area without excessive bleeding. This can cause tears in the aorta, in addition to dislodging cholesterol plaques that can travel elsewhere in the body to cause damage--such as in the brain or to the kidney itself.
This complication is usually a result of decreased blood to the kidney during surgery. This manifests as decreased urine production. The best way to prevent it is good technique during surgery to ensure the kidney doesn't go long periods without adequate blood flow.
This is most common during laparoscopic kidney surgery because of the decreased visual field that a surgeon has when using a camera to view the surgery. Injuries can occur out of the view of the surgeon and manifest as persistent pain with subsequent abdominal symptoms such as diarrhea, nausea and persistent bowel sounds. It can progress to seriously threaten the patient’s life, so the surgeon must be vigilant after laparoscopic procedures.
Blood Vessel Injury
This can also occur in laparoscopic surgeries, due to the same problems with visualization that result in bowel injury. Many important blood vessels in the area can be damaged during surgery that can elude the surgeons view, so vigilance is crucial.
- “Campbell-Walsh Urology, 9th Edition;” Wein; 2007
- Urology. “Complications of Transperitoneal Laparoscopic Nephrectomy: A Single-center Experience.” Kim B, Yoo E, Kwon T. Volume 73, Issue 6 (June 2009)
- “Sabiston Textbook of Surgery, 18th Edition;” Townsend; 2007