Nephrectomy: indications, complications and mortality in 154 consecutive patients.

Objective: To gain information about the indications for and complications of conventional nephrectomy as practiced in a teaching hospital of Pakistan.

Methods: Medical records of patients who underwent nephrectomy during five years period from January 2001 to December 2005 were studied with regards to clinical presentation, indication for nephrectomy, histopathological report, post-operative complications and mortality. The indications for nephrectomy were divided into benign and malignant conditions.

Results: Out of 154 nephrectomies, 118 (76.6%) were performed for benign condition and 36 (23%) for malignant etiology. In the benign group, majority (i.e. 53.3%) of the patients had kidneys removed due to renal stone. Other conditions in this group included chronic pyelonephritis (20%), neglected ureteropelvic junction obstruction (16%), renal tuberculosis (7.6%) and iatrogenic (2.5%). Thirty-six (23%) patients had nephrectomy for malignant conditions i.e. renal cell carcinoma. Malignant tumors were more common in males while benign conditions necessitating nephrectomy were predominant in female patients. Patients with benign conditions were much younger (mean age 32 years) than patients in malignant group (mean age 52.8 years). Nephrectomy for malignant disease had a higher rate of complications (13.8%) than for benign conditions (7.6%). The re-operation rate was 1.29% for all patients who underwent nephrectomy. Two patients, one in each group, died post-operatively and the overall 30-day mortality was 1.29%

Conclusion: The mean age of the patients undergoing nephrectomy for benign and malignant conditions was lower than reported from western countries. In our series there was a much higher rate of nephrectomy performed for benign conditions. Renal stone related etiology was the major indication for nephrectomy. Malignant renal tumours affected patients at a remarkably younger age and clear cell renal carcinoma was the predominant histological variety. Nephrectomy for malignant conditions had a higher rate of complications than for benign conditions while there was no difference in the overall mortality.