Surgical removal of one kidney (unilateral nephrectomy).

Conditions involving the kidney that could be the cause for kidney removal are as follows:

• Renal adenocarcinoma

• Renal congenital disorder

• Polycystic kidney disease

• Any benign condition that causes severe infection (kidney stones)

• Profuse bleeding

• Massive trauma

• Infarction of a renal blood vessel

• Ureteral stricture.

Manifestations of conditions that could necessitate kidney removal are as follows:

• Renal adenocarcinoma: Hematuria, flank pain, fever of unknown origin (FUO), increased red blood cells due to stimulation to form new cells (erythropoietin activity), palpable mass, and hypertension.

• Renal congenital disorder: Severe colic pain, burning on urination, and pyelonephritis.

• Polycystic kidney disease: Gross kidney enlargement, recurrent hematuria, proteinuria, life-threatening bleeding behind the peritoneum, abdominal pain, swollen abdomen, and large masses on both flanks.

• Infarction of a renal artery: Costovertebral tenderness, flank pain, severe abdominal pain, anorexia, nausea, and vomiting.

• Ureteral stricture: Enlarged ureter, and enlarged kidney due to obstruction of urine (hydronephrosis).

• Kidney stones: Pain, blood in the urine, and frequent kidney infections.

Tests for conditions that could necessitate kidney removal are as follows:

• Renal adenocarcinoma: Ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), and dye studies of the aorta and renal artery.

• Renal congenital disorder: Intravenous dye studies of the kidney pelvis, and tests for increased calcium in the urine.

• Polycystic kidney disease: Intravenous dye studies of the kidney pelvis, ultrasound CT, creatinine clearance, and urinalysis.

• Infarction of a renal artery: Elevated urine enzyme levels, increased white blood cell (WBC) counts, elevated sedimentation rates, and a scan.

• Ureteral stricture: Ultrasound, x-rays of the bladder while voiding, and intravenous pyelogram.

• Kidney stones: Ultrasound, and intravenous dye studies.

Treatments for conditions that could necessitate kidney removal are as follows:

• Renal adenocarcinoma: A need for a radical nephrectomy and removal of lymph nodes may be indicated.

• Renal congenital disorder: Increased fluid intake, treatment of infection, and removal of stones. Nephrectomy is required only if there is severe hemorrhage or infection.

• Polycystic kidney disease: Careful monitoring and management of infections is required. Patients may undergo dialysis or transplantation. Nephrectomy is not recommended unless severe infection or bleeding makes it mandatory.

• Infarction of a renal artery: Surgical repair of the occlusion or nephrectomy may be needed.

• Ureteral stricture: If repair is not possible, a nephrectomy is done for severe renal damage.

Surgical removal of a kidney could result in any of the postoperative complications: hypostatic pneumonia that occurs from immobility; atelectasis; emboli in the lungs; hypovolemia; septicemia; shock; wound infection; temporary paralytic ileus; and postoperative psychosis.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350 (i) (1) – Total plus 60% and – Special Monthly Compensation (SMC).

• Any pathology of remaining kidney is treated as though it was also service connected. (38 CFR 3.383(a)(2) [Special consideration for paired organs and extremities])

• The new criteria for the genitourinary body system became effective November 14, 2021.  Ensure consideration is given to historic criteria prior to evaluating disabilities established prior to that date. 

• If kidney removal is the result of voluntary kidney donation, the removal and any expected residuals thereof are no subject to service connection, as it is considered elective surgery and does not meet the provisions of a disease or injury occurred in or due to service.  [38 CFR 3.303; 38 CFR 3.304(b)(1)]

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date. 38 CFR 3.951(a)

Notes

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.