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Living with one kidney after nephroureterectomy | CION Cancer Clinics
After a nephroureterectomy, most people live well on the one kidney that is left. That kidney takes on more of the work, but your blood tests will usually show some drop in overall kidney function, and for a few people that drop matters. This page explains the tests you will see, what changes over time, how to protect the remaining kidney, and why kidney function shapes later treatment. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Can you live normally with one kidney after this operation?
- Which kidney tests will you see, and what do they mean?
- How does kidney function usually change after surgery?
- How can you protect the kidney you have left?
- Three things families tell us, and what is actually true
- Why does kidney function shape later treatment, and what can this page not tell you?
- Common questions about kidney function after nephroureterectomy
The short answer
Can you live normally with one kidney after this operation?
Yes, most people can. One healthy kidney can filter enough blood for normal daily life, and it gradually takes on some of the work the removed kidney used to do.
Why your blood tests will still change
Taking out a kidney removes part of your filtering capacity overnight. The remaining kidney works harder over the following months, but it rarely makes up the whole difference. So your creatinine, a waste product measured in the blood, usually rises a little. Your eGFR, the estimate of how well the kidneys filter, usually falls. For many people this new level stays steady and causes no symptoms.
Why it matters more for some people
Many people with upper tract cancer are older, and many have diabetes or high blood pressure. Their kidneys may already have been working below normal before the operation. On the other hand, the kidney that is removed was sometimes already doing little, because the tumour had blocked it. In that case the change afterwards can be small. Before the operation, your team can look at how much each kidney contributes, so the likely change can be explained to you in advance.
On your report
Which kidney tests will you see, and what do they mean?
- Serum creatinine
- A waste product from muscle that healthy kidneys clear. A higher number usually means the kidneys are filtering less.
- eGFR
- An estimate of how much blood your kidneys filter, worked out from creatinine, age and sex. A lower number means less filtering.
- CKD stage
- Chronic kidney disease, grouped into stages by eGFR. Many people reach an early stage after losing a kidney and stay there.
- Urine protein or albumin
- Protein leaking into the urine. It is an early sign that the kidney is under strain.
- Split function scan
- A nuclear scan, often called a DTPA or DMSA scan, that shows what share of the work each kidney does.
Not sure whether this applies to you?
Ask an oncologistOver time
How does kidney function usually change after surgery?
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In hospital
Blood tests are checked often in the first days. Creatinine often rises and then settles. You will be encouraged to drink, and the amount of urine you pass is measured, because the remaining kidney is doing all the work from the moment you wake.
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The first weeks at home
Your body is healing and your appetite is coming back. A blood test at the first follow-up visit shows the early new level. Painkillers and any new medicines are reviewed with the single kidney in mind.
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The first months
The remaining kidney adapts, and filtering often improves a little from its lowest point. This is when your team gets a clearer idea of your settled level.
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The longer term
Kidney function is checked at follow-up visits, alongside scans and bladder checks for the cancer. For most people it stays steady. Diabetes, high blood pressure, dehydration and some medicines are the usual reasons it drifts down, which is why those are watched.
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If function drops further
You may be referred to a nephrologist. Only a small number of people go on to need dialysis, and they are usually people whose kidneys were already weak before surgery.
Everyday care
How can you protect the kidney you have left?
These are not strict new rules for life. They are habits that give one kidney an easier job.
Keep blood pressure controlled
High blood pressure slowly damages the tiny filters in the kidney. Keep taking prescribed blood pressure medicines and have the reading checked regularly.
Ask your doctor
- What your target reading is
- Whether any tablet needs a review now
Keep diabetes steady
High sugar over years harms the kidneys. Keeping your long-term sugar test, the HbA1c, within your target protects the kidney that is left.
Be careful with painkillers
Some common painkillers, such as ibuprofen and diclofenac, can strain the kidneys. Ask your doctor or pharmacist before taking any painkiller bought over the counter. Do not stop or change a prescribed medicine on your own.
Drink enough, especially in the heat
Dehydration in a Hyderabad summer, or with loose motions or vomiting, can cause a sudden dip in kidney function. Ask your team how much fluid suits you, because it depends on your heart too.
Mention it before scans with dye
The dye used in some CT scans can strain the kidney. Tell the scan centre you have one kidney, so they can check a recent blood test first.
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One thing that cannot wait
If you are passing very little urine, or none for most of a day, or you have swelling of the legs or face with breathlessness, go to the nearest emergency department the same day. Say you have one kidney after cancer surgery. The same applies to a high fever with shivering, or pain in the side of the remaining kidney. Do not wait for your next appointment, and do not take a painkiller first to see if it settles.
Commonly believed
Three things families tell us, and what is actually true
"With one kidney, he must drink as much water as possible."
Drinking enough matters, but forcing very large amounts does not help the kidney and can harm someone with heart trouble. The right amount depends on the person. Ask your team for a sensible daily target rather than following a rule from a relative.
"One kidney means no protein or salt ever again."
Most people with one healthy kidney do not need a special diet. Moderate salt helps blood pressure. Strict protein limits are for advanced kidney disease, and a kidney specialist or dietitian sets them. Cutting food back too hard slows recovery from the operation.
"A higher creatinine means the cancer is in the other kidney."
A rise after the operation is expected, because there is less kidney doing the work. It says nothing about the cancer. The other kidney is checked for cancer with scans and sometimes a telescope, not with this blood test.
Being straight with you
Why does kidney function shape later treatment, and what can this page not tell you?
Kidney function decides which chemotherapy is safe. Cisplatin, a common chemotherapy medicine for this type of cancer, is cleared by the kidneys and can harm them, so it needs good kidney function. After a kidney is removed, some people no longer qualify for it. This is one reason teams sometimes discuss chemotherapy before the operation, while both kidneys are still working. Carboplatin, a related medicine, is often used when kidney function is lower.
Who is more likely to have a real problem?
People whose eGFR was already low before surgery. People with long-standing diabetes or high blood pressure. Older people. Anyone whose remaining kidney has its own disease, a stone, or a narrowed tube draining it.
What this page cannot tell you
It cannot tell you what your own kidney function will settle at, or whether you will be able to have a particular treatment. That depends on your blood tests before and after the operation, the split function scan and your other conditions. Bring your reports to the follow-up visit and ask your team to explain the numbers to you.
Questions we are asked
Common questions about kidney function after nephroureterectomy
Will I need dialysis after losing a kidney?
Most people do not. One kidney is usually enough for normal life. Dialysis becomes a real possibility mainly when both kidneys were already working poorly before the operation. If that is your situation, your surgeon should explain the risk and may involve a kidney specialist before surgery, so the plan is made with it in mind.
How often will my kidney function be checked?
Usually at each follow-up visit, alongside the scans and bladder checks for the cancer. Checks are closer together in the first months while the remaining kidney adjusts, and further apart once the level has settled. Your team sets the timing, and it may be closer if you have diabetes or are having chemotherapy.
Can I take paracetamol for pain?
Paracetamol is generally considered gentler on the kidneys than painkillers such as ibuprofen or diclofenac, but it still has to be taken as advised. Ask your doctor or pharmacist which painkiller and how much suits you, and do not change a prescribed medicine on your own.
Should I follow a special kidney diet?
Most people with one healthy kidney do not need one. A normal balanced diet with moderate salt is usually enough. If your blood tests show reduced function, your doctor or a dietitian may give specific advice about salt, protein or potassium. Avoid strict diets from the internet without checking first.
Can I go back to work and exercise?
Yes, once you have recovered from the operation. Walking, yoga and most jobs are fine. Contact sports that risk a hard blow to the side are worth discussing with your doctor first. Heavy lifting waits until the wound has healed, and your surgeon will tell you when that is.
Does kidney function affect whether I can have chemotherapy?
Yes. Some chemotherapy medicines used for this cancer need good kidney function. If yours has dropped, your oncologist may choose a different medicine, change the plan or suggest another kind of treatment. This is decided case by case, and a lower eGFR does not mean no treatment is possible.
Why was I sent for a kidney scan before surgery?
A split function scan shows how much of the work each kidney does. If the kidney with the tumour was already contributing little, removing it changes less. If the remaining kidney is weak, your team may consider kidney-sparing surgery or plan more carefully. It helps the team tell you what to expect.
Is it safe to have CT scans with dye during follow-up?
Usually yes, with some care. The team checks a recent kidney blood test before giving the dye and may ask you to drink fluids around the scan. If your function is low, a scan without dye or a different kind of scan may be chosen. Always tell the scan centre you have one kidney.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NHS — Chronic kidney disease
- National Cancer Institute — Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ) - Patient Version
- American Cancer Society — Chemotherapy for bladder cancer
- Cancer Research UK — Kidney cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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