As pessoas nascem com dois rins, mas realmente precisam apenas de um: um único rim saudável pode funcionar bem, como dois rins. Mas se ambos os rins forem removidos, a diálise ou um transplante será necessário para manter a vida.
Os riscos de uma nefrectomia do doador para um transplante renal são muito pequenos. Todos os doadores vivos passam por cuidadosas avaliações pré-operatórias para garantir que estejam saudáveis o suficiente para a cirurgia. A grande maioria dos doadores de rim vive uma vida longa e saudável com um único órgão.
O que é nefrectomia?
Nefrectomia (do grego: nefro = rim + ectomia = remoção) é a remoção cirúrgica de um dos rins. A nefrectomia de um rim doente pode ser parcial ou total (radical). Na nefrectomia parcial, apenas a parte doente ou lesada do rim é removida. A nefrectomia radical envolve a remoção de todo o rim, juntamente com uma seção do ureter, que leva à bexiga, da glândula suprarrenal, que fica no topo do rim, e do tecido adiposo ao redor do órgão. Quando os dois rinssão removidos ao mesmo tempo, o procedimento é chamado de nefrectomia bilateral.
Quais são os motivos para se fazer uma nefrectomia?
A nefrectomia é feita para tratar o câncer renal, bem como outras doenças e lesões renais graves. Também é feita para remover um rim saudável de um doador (vivo ou morto) a ser transplantado em um receptor.
Como é feita a nefrectomia?
A nefrectomia pode ser feita por cirurgia laparoscópica, também chamada de cirurgia minimamente invasiva. A cirurgia laparoscópica envolve o uso de um laparoscópio, um aparelho que contém uma pequena câmera e que é passado através de uma série de pequenas incisões na parede abdominal, usado para visualizar a cavidade abdominal e remover o rim através de uma pequena incisão. Esse procedimento é feito sob anestesia geral.
Uma vez realizada a cirurgia, será colocado um cateter vesical que será removido várias horas após a cirurgia. As vantagens da cirurgia laparoscópica sobre a cirurgia aberta incluem menor tempo de recuperação, estadia hospitalar mais curta, incisões menores e menos complicações pós-operatórias. No entanto, nem todo cirurgião tem experiência nesse tipo de procedimento e nem todo hospital tem condição de realizá-lo.
A nefrectomia aberta também é feita sob anestesia geral e raramente é necessária. O cirurgião faz uma incisão no lado do abdômen em que o rim será abordado (área do flanco). Uma costela pode precisar ser removida para realizar o procedimento. O ureter (tubo que transporta a urina do rim para a bexiga) e os vasos sanguíneos são seccionados do rim e o rim é removido. A incisão é então fechada com pontos.
E depois da nefrectomia?
O paciente provavelmente permanecerá no hospital por 1 a 7 dias, dependendo do método de cirurgia utilizado. Após a cirurgia, a equipe médica observará cuidadosamente a pressão arterial e o equilíbrio de eletrólitos e de fluidos, funções do corpo que normalmente são controladas em parte pelos rins.
Provavelmente o paciente terá de usar um cateter urinário, tubo para drenar a urina da bexiga, por um curto período de tempo durante a sua recuperação. Por algum tempo, o paciente pode ter desconforto e dormência perto da área da incisão, devido à secção dos nervos. Analgésicos devem ser administrados após o procedimento cirúrgico e durante o período de recuperação, conforme necessário.
A respiração profunda e a tosse podem ser dolorosas porque a incisão é feita muito próxima ao diafragma. Uma fisioterapia respiratória é muito importante para prevenir a pneumonia. Atividade extenuante e de trabalho pesado devem ser evitados por seis semanas, pelo menos, após o procedimento.
O rim remanescente deve ser regularmente testado para verificar quão bem está funcionando. Um exame de urina e medida da pressão arterial devem ser feitos regularmente a cada ano, pelo menos, e indicadores da função renal(creatinina, taxa de filtração glomerular [TFG]) devem ser também verificados a cada ano (ou mais frequentemente, se resultados anormais forem encontrados). Também devem ser realizados testes regulares de urina, principalmente visando avaliar as proteínas, porque a presença de proteína na urina pode significar algum dano renal.
Pessoas com apenas um rim devem evitar esportes como boxe, hóquei, futebol, artes marciais, rodeio, etc., que envolvem maiores riscos de contato pesado ou colisão. Também devem ser evitadas atividades extremas e radicais, como paraquedismo, rapel, etc. Qualquer um com um único rim que decida participar desses esportes deve ser extremamente cuidadoso e usar um protetor acolchoado, porque o paciente deve entender que perder o rimremanescente é uma situação muito séria.
Quais são as complicações possíveis da nefrectomia?
Toda cirurgia tem certos riscos e complicações. Possíveis complicações da cirurgia de nefrectomia incluem: infecção; sangramento, às vezes requerendo transfusão de sangue; pneumonia pós-operatória; raras reações alérgicas à anestesia e, eventualmente, morte. Há também um pequeno risco de insuficiência renal, num paciente com função reduzida do rim remanescente.
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