Nephrectomy May Reduce Kidney Volume Without Accelerating eGFR Decline: Study

A new study published in the BMC Nephrology found kidney volume to decrease after nephrectomy in patients undergoing kidney replacement therapy (KRT). Among two patients who underwent nephrectomy of a functioning kidney without immediately starting KRT, the procedure did not appear to accelerate estimated glomerular filtration rate (eGFR) decline in the remaining kidney. However, because this was a small case series, the findings require confirmation in larger, prospective multicenter studies.

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the gradual growth of fluid-filled cysts in the kidneys and, in many patients, the liver. As the disease advances, some individuals require nephrectomy due to severe pain, recurrent infections, bleeding, or to create space for kidney transplantation. However, studies have questioned whether removing a kidney could lower intra-abdominal pressure, potentially allowing the remaining kidney or liver cysts to expand more rapidly and hasten kidney function decline.

To investigate this possibility, this retrospective case series comparing changes in kidney and liver volumes among patients who underwent nephrectomy at the time they initiated KRT with a control group that started KRT without nephrectomy. Organ volumes were assessed using MRI with an automated stereological approach or manual CT-based measurements. The investigators also evaluated changes in eGFR in a small group of patients who underwent nephrectomy but did not immediately require KRT.

The study included 12 patients in the nephrectomy-KRT group and 10 patients in the KRT-only control group. Before starting KRT, kidney volume growth rates were comparable between the two groups, with no statistically significant difference. Following the initiation of KRT, kidney volumes decreased significantly in both groups, and the rate of volume reduction was similar regardless of whether nephrectomy had been performed.

Also, this research found no significant difference in liver volume changes between the nephrectomy and control groups, suggesting that nephrectomy did not stimulate accelerated liver cyst growth.

In a separate analysis of four patients who retained sufficient kidney function after nephrectomy, the investigators examined whether removing one functional kidney hastened the decline of the remaining kidney. Overall, the findings indicated that the rate of eGFR decline remained unchanged after surgery, providing additional reassurance that nephrectomy did not adversely affect residual kidney function in these patients.

Source:

Geertsema, P., Bais, T., Doornweerd, B. H. J., van Gastel, M. D. A., Meijer, E., Pol, R. A., Gansevoort, R. T., & Casteleijn, N. F. (2026). The impact of nephrectomy on liver and contralateral kidney volume in patients with ADPKD; a case series. BMC Nephrology. https://doi.org/10.1186/s12882-026-05237-w