Nephrology is a medical specialty focused on the function and diseases of the kidneys. While nephrologists themselves primarily perform minimally invasive procedures (like biopsies and catheter placements), they work closely with urologists and transplant surgeons for major surgical interventions.

Here is a breakdown of the common surgeries and procedures related to kidney care:

1. Dialysis Access Surgeries

For patients with end-stage renal disease (ESRD), creating a reliable “lifeline” for dialysis is one of the most common surgical needs.

• AV Fistula Creation: A surgeon connects an artery directly to a vein (usually in the arm) to create a robust access point for hemodialysis. This is considered the “gold standard” for long-term dialysis.

• AV Graft Placement: If a patient’s veins are too small for a fistula, a synthetic tube (graft) is used to connect the artery and vein.

• Peritoneal Dialysis (PD) Catheter Insertion: A small tube is surgically placed into the abdomen to allow dialysis fluid to enter and exit the peritoneal cavity.

2. Kidney Removal and Reconstruction

These surgeries are often necessary for treating tumors, severe infection, or congenital defects.

• Nephrectomy: The surgical removal of a kidney.

  • Radical: Removal of the entire kidney, surrounding fat, and sometimes the adrenal gland.

  • Partial (Nephron-Sparing): Only the diseased portion or tumor is removed, preserving the healthy part of the kidney.

• Donor Nephrectomy: The surgical removal of a healthy kidney from a living donor for transplantation.

• Pyeloplasty: A reconstructive surgery used to clear a blockage at the junction where the kidney meets the ureter (UPJ obstruction).

3. Kidney Transplantation

This is the most complex nephrology-related surgery, involving the placement of a healthy donor kidney into a patient whose kidneys no longer function.

• Procedure: The new kidney is typically placed in the lower abdomen (iliac fossa), and its blood vessels are connected to the patient’s iliac artery and vein.

• Post-Op: While the surgery is performed by transplant surgeons, the long-term management of the “graft” (the new kidney) is handled by nephrologists.

4. Kidney Stone Surgeries

When stones are too large to pass naturally, several surgical options are available:

• Shock Wave Lithotripsy (SWL): Non-invasive shock waves break stones into small fragments.

• Ureteroscopy (URS): A thin scope is passed through the urethra to the stone, which is then broken up with a laser.

• Percutaneous Nephrolithotomy (PCNL): For very large stones, a small incision is made in the back to remove the stone directly from the kidney.

5. Common “In-Office” Nephrology Procedures

These are typically performed by nephrologists rather than surgeons, often using ultrasound guidance:

• Kidney Biopsy: A needle is used to take a tiny sample of kidney tissue to diagnose specific diseases like glomerulonephritis.

• Temporary Dialysis Catheter Placement: Inserting a “central line” into a large vein (usually in the neck or groin) for immediate, short-term dialysis.