Does my mother need a nephrectomy?

Q: My mother has a hydronephrotic left kidney with a GFR of 3.4 ml/min and function 11.5% and right kidney (GFR – 26 ml/min & function - 88.5%). We have met two nephrologists and three urologists among those two urologists and one nephrologist suggested left lap nephrectomy and others suggested DJ stand. We are confused since my mother is not diabetic but anaemic (Hb-9) and weak.

A:First of all, there are definite indications for nephrectomy (surgical removal of kidney) and these are recurrent kidney infection with associated complications including pain that are not responding to antibiotic/medical therapy. Other one is kidney cancer or a mass suspicious of being cancerous. It doesn’t seem that your mother has either of these conditions. Cause of left sided hydronephrosis needs to be looked into before deciding next course of treatment, which might include placement of stent in the urinary tract on the left side to relieve the obstruction thereby reducing the swelling (hydronephrosis). But it is futile to pursue any further treatment for the left sided hydronephrosis if its proven that left kidney is totally non-functioning. I think that even with a residual left kidney function of 11.5%, any planned intervention to salvage and prevent further damage to the left kidney would be justified. So, placement of stent would be justified based upon the cause of left sided hydronephrosis unless above detailed indications makes it imperative to perform nephrectomy.