Acute renal failure following laparoscopic cholecystectomy: a case report.
Ben-David B,Croitoru M,Gaitini L
Journal of clinical anesthesia
The carbon dioxide (CO2) pneumoperitoneum of laparoscopic surgery is a complex physiologic event associated with neuroendocrine, respiratory, cardiovascular, and renal disturbances, as well as compromised organ blood flow. A case is presented of a 67-year-old man with a history of chronic renal failure, renal tubular acidosis, and hypertension, who underwent an uneventful elective laparoscopic cholecystectomy that included 75 minutes of CO2 pneumoperitoneum of 15 mmHg pressure. Postoperatively, the patient developed acute renal failure from which he recovered within 2 weeks. In the absence of other evident precipitating factors, we suspect that the CO2 pneumoperitoneum played a causal role in the development of his acute renal failure. The potential seriousness of the physiologic insult of conventional CO2 pneumoperitoneum suggests that "minimal access" surgery is not necessarily "minimally invasive."
Kidney safety during surgical pneumoperitoneum: an experimental study in rats.
de Barros Rogério Fortunato,Miranda Márcio Lopes,de Mattos Amilcar Castro,Gontijo José Antonio Rocha,Silva Vinicius Rodrigues,Iorio Brayner,Bustorff-Silva Joaquim M
Surgical endoscopy
BACKGROUND:Elevations of intraabdominal pressure during laparoscopic procedures may lead to oliguria or anuria in mammals. Despite this, previous research has not been able to confirm an associated kidney injury. This study aimed to investigate the occurrence of an early kidney lesion secondary to surgical pneumoperitoneum in a rat model using the expression of neutrophil gelatinase-associated lipocalin (N-GAL) as a biomarker for early kidney injury. METHODS:In this study, 20 male Sprague-Dawley rats under general anesthesia and mechanically ventilated were allocated to one of five experimental time-dependent groups: group 1 (1-h control), group 2 (1-h pneumoperitoneum), group 3 (2-h control), group 4 (2-h pneumoperitoneum), and group 5 (positive kidney injury group induced by intravenous administration of cisplatin 7.5 mg/kg). To evaluate the renal expression of N-GAL 24 h after the procedure, all the rats underwent a 2-h urine output evaluation as well as laparotomy and bilateral nephrectomy performed sequentially to investigate the presence of renal injury using immunofluorescence qualification and western blotting. RESULTS:Urine output was reduced and N-GAL expression was increased in the animals from the cisplatin group. The animals undergoing 1- or 2-h pneumoperitoneum displayed urine output and N-GAL expression similar to that of the animals from the matching control groups. CONCLUSIONS:Under the experimental conditions of this study, the animals with normal preoperative renal function did not show any type of acute kidney injury associated with the presence of a stabilized surgical pneumoperitoneum.
10.1007/s00464-012-2322-4
Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury-A Review of Basic Physiology.
Journal of clinical medicine
Acute kidney injury (AKI), especially if recurring, represents a risk factor for future chronic kidney disease. In intensive care units, increased intra-abdominal pressure is well-recognized as a significant contributor to AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance and examples. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumo-peritoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumo-peritoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumo-peritoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.
10.3390/jcm11102728
Short-term impact of carbon dioxide, helium, and gasless laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient.
Hazebroek E J,de Bruin R W F,Bouvy N D,van Duikeren S,Bonthuis F,Marquet R L,Bajema I M,Hayes D P,IJzermans J N M,Bonjer H J
Surgical endoscopy
BACKGROUND:Laparoscopic donor nephrectomy has the potential to increase the number of living kidney donations by reducing donor morbidity. However, studies have shown that raised intraabdominal pressure can result in transient renal dysfunction. Therefore, laparoscopically procured kidneys might be at higher risk for suffering a period of ischemia during pneumoperitoneum. The objective of this study was to investigate the short-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient. METHODS:EXPERIMENT 1: KIDNEY DONOR: Initially, 36 brown Norway (BN) rats were randomized for three procedures: 2 h of carbon dioxide (CO2) insufflation (8 mmHg), 2 h of helium insufflation (8 mmHg), and 2 h of gasless technique (0 mmHg). After this, a unilateral nephrectomy was performed in all the animals. EXPERIMENT 2: RECIPIENT: Subsequently, 36 donor BN rats were subjected to a similar insufflation protocol, but after nephrectomy, a syngeneic kidney transplantation (BN-BN) was performed. Urine and blood samples were collected on postoperative days 1, 3, 7, and 14 for determination of renal function. Subsequently, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis. RESULTS:In both donors and recipients, no significant changes in serum creatinine, proteinuria, or glomular filtration were detected between the CO2, the helium, and the gasless control groups. In both experiments, histologic analysis of Kidney specimens did not show any deleterious effects from abdominal gas insufflation. Although kidney grafts exposed to CO2 showed significantly higher numbers of CD45+ leukocytes 3 days after transplantation, immunohistochemical analysis did not show significant differences in number of infiltrating cells (CD4, CD8, ED1, OX6, OX62) between the two insufflation groups and the gasless control subjects. CONCLUSIONS:Abdominal gas insufflation does not have an adverse effect on the renal function of the kidney donor 1 week after laparoscopic donor nephrectomy. No differences in renal function or histomorphology were detected between syngeneic kidney grafts exposed to pneumoperitoneum and gasless control subjects.
10.1007/s00464-001-8169-8
Pneumoperitoneum in the presence of acute and chronic kidney injury: an experimental model in rats.
Dolkart Oleg,Khoury Wisam,Amar Eyal,Weinbroum Avi A
The Journal of urology
PURPOSE:There is evidence that pneumoperitoneum induces transient changes in renal function in healthy individuals. Its effect on malfunctioning kidneys is not well known. We investigated effects caused by pneumoperitoneum in animals with impaired renal function. MATERIALS AND METHODS:Male Wistar rats underwent subtotal (5/6) nephrectomy in 2 sequential steps to induce renal failure. Two and 10 weeks postoperatively rats were classified with acute and chronic kidney injury, respectively. At those time points all rats were exposed to 0, 5 and 8 mm Hg pneumoperitoneum for 60 minutes. Changes in creatinine, blood urea nitrogen and creatinine clearance were measured. Histopathological changes and apoptosis were also evaluated in the subgroups. RESULTS:A total of 18 rats with acute and 18 with chronic kidney injury completed the study. Creatinine and blood urea nitrogen did not change after applying pneumoperitoneum in the different pressure subgroups but creatinine clearance significantly decreased in the 5 and 8 mm Hg subgroups in rats with acute and chronic kidney injury. Histopathological findings in the acute kidney injury subgroups that underwent 5 and 8 mm Hg pressure revealed ischemic changes while compensatory hypertrophy was noticed in the chronic injury pressurized subgroups. The apoptotic count was significantly higher in the chronic injury subgroups compared to their acute injury pressurized counterparts. CONCLUSIONS:Pneumoperitoneum seems feasible in rats with impaired baseline renal function. Particularly chronic cases should not be considered a contraindication to pneumoperitoneum while in acute cases pneumoperitoneum might be detrimental.
10.1016/j.juro.2014.03.114
Laparoscopic cholecystectomy and time-course changes in renal function. The effect of the retraction method on renal function.
Miki Y,Iwase K,Kamiike W,Taniguchi E,Sakaguchi K,Sumimura J,Matsuda H,Nagai I
Surgical endoscopy
BACKGROUND:Recently, the retraction method has been used to reduce intraabdominal pressure (IAP) during laparoscopic surgery. The purpose of this study was to determine the serial changes in renal function during laparoscopic cholecystectomy (LC) using the retraction method. METHODS:Urine output, effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) were measured serially in seven patients who underwent LC with 12 mmHg pneumoperitoneum (High-IAP group) and five who underwent LC using the retraction method with 4 mmHg pneumoperitoneum (Low-IAP group). RESULTS:Urine output, ERPF, and GFR were decreased during pneumoperitoneum in the High-IAP group, whereas no significant changes in any of these parameters were observed in the Low-IAP group. CONCLUSIONS:Our findings demonstrate that reduction of IAP to 4 mmHg using the retraction method prevents the transient renal dysfunction caused by prolonged 12 mmHg pneumoperitoneum during LC, suggesting that the retraction method reduces the risk of perioperative renal dysfunction during laparoscopic surgery.
Long-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient rats.
Hazebroek Eric J,de Bruin Ron W F,Bouvy Nicole D,Marquet Richard L,Bonthuis Fred,Bajema Ingeborg M,Hayes Don P,Ijzermans Jan N M,Bonjer H Jaap
Annals of surgery
OBJECTIVE:To investigate the long-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient. SUMMARY BACKGROUND DATA:Laparoscopic donor nephrectomy has the potential to increase the number of living kidney donations by reducing donor morbidity. However, function of laparoscopically procured kidneys might be at risk due to ischemia as a consequence of elevated intra-abdominal pressure during laparoscopy. METHODS:In experiment 1, 30 Brown Norway rats were randomized to three procedures: 2 hours of CO2 insufflation, 2 hours of helium insufflation, and 2 hours of gasless laparoscopy. After this, a unilateral nephrectomy was performed in all animals. Another six rats were used as controls. In experiment 2, 36 donor Brown Norway rats were subjected to a similar insufflation protocol, but after nephrectomy a syngeneic renal transplantation was performed. All rats had a follow-up period of 12 months. Urine and blood samples were collected each month for determination of renal function. After 1 year, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis. RESULTS:In donors as well as in recipients, no significant changes in serum creatinine, proteinuria, or glomerular filtration rate were detected between the CO2, the helium, and the gasless control group after 1 year. No histologic abnormalities due to abdominal gas insufflation were found. Immunohistochemical analysis did not show significant differences in the number of infiltrating cells (CD4, CD8, ED1, OX62, and OX6) and adhesion molecule expression (ICAM-1) between the three groups. CONCLUSIONS:Abdominal gas insufflation does not impair renal function in the donor 1 year after LDN. One year after transplantation, no differences in renal function or histomorphology were detected between kidney grafts exposed to either pneumoperitoneum or a gasless procedure.
10.1097/01.SLA.0000055272.96210.A0
Effects of increased intra-abdominal pressure and volume expansion on renal function in the rat.
Lindström Pernilla,Wadström Jonas,Ollerstam Anna,Johnsson Cecilia,Persson A Erik G
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
BACKGROUND:The effects of increased intra-abdominal pressure (IAP) and volume expansion on renal function in the rat were studied to gain more knowledge of the oliguria seen during laparoscopic procedures and to reduce the detrimental renal effects of IAP. METHODS:IAP was elevated to 5 or 10 mmHg by insufflation of CO(2) and maintained for 2 h in anaesthetized and mechanically ventilated rats. Rats with normal IAP served as controls. An angiotensin II receptor I antagonist, candesartan, was given as a bolus injection and a 5% volume expansion was achieved by i.v. saline infusion. An angiotensin-converting enzyme (ACE) inhibitor was also given. Renal parameters were the glomerular filtration rate (GFR), urine production, the urinary concentrations of sodium and potassium and the osmolality in the urine. The arterial acid-base balance and blood pressure were also monitored. RESULTS:The GFR deteriorated by 70% during pneumoperitoneum (PP) of 10 mmHg. There was a dramatic drop in sodium excretion (88-97%). With candesartan and elevated IAP, there was a drop in mean arterial pressure (from 90 to 55 mmHg) and the negative renal effects were very pronounced. Renal function was better preserved during elevated IAP in combination with volume expansion. CONCLUSIONS:Capnoperitoneum suppresses renal function, especially in combination with angiotensin II receptor 1 blockade and ACE inhibition. Volume expansion reduces the deleterious effects of PP on renal function during elevated IAP. The results suggest that patients should not be given pharmaceuticals blocking the renin-angiotensin-aldosterone system prior to procedures that may increase IAP. It may be beneficial, however, to reduce angiotensin II tension by volume expansion.
10.1093/ndt/gfg362
Renal apoptosis following carbon dioxide pneumoperitoneum in a rat model.
Khoury Wisam,Jakowlev Ksenia,Fein Amos,Orenstein Hassida,Nakache Richard,Weinbroum Avi A
The Journal of urology
PURPOSE:Laparoscopically recruited kidneys regain normal function more slowly than laparotomy harvested organs for several possible reasons. We investigated the effects of CO(2) induced pneumoperitoneum on kidney function, as reflected by blood and urine creatinine levels, and its relation with renal cell apoptosis. MATERIALS AND METHODS:CO(2) pneumoperitoneum was established in anesthetized Wistar male rats that were randomly allocated at 6 per group into 1 of 6 groups with an intraperitoneal pressure of 0 (control), 5, 8, 12, 15 or 18 mm Hg. Pressure was maintained for 60 minutes in all groups. Three additional groups were subjected to 30-minute pneumoperitoneum at 0, 12 and 18 mm Hg, respectively. The rats were kept alive for the ensuing 24 hours, after which blood and urine creatinine were analyzed and the abdominal organs were harvested. Various areas of the organs were analyzed for apoptotic cells using the TUNEL method. Cells were randomly counted in 10 eyeshots in 3 sections each using an ocular micrometer. RESULTS:Creatinine levels in blood and urine changed as pressure and pneumoperitoneum duration progressed. Isolated TUNEL positive nuclei were detected in the outer medulla and the cortex of control kidneys. There was a significantly higher number of TUNEL positive nuclei in the cortex and the medulla of all pressurized kidneys (p <0.05), which increased in parallel with increasing intraperitoneal pressure and pneumoperitoneum exposure time. CONCLUSIONS:The CO(2) pneumoperitoneum gradient and its duration affect renal function and induce apoptosis. This could be a mechanism involved in renal delayed graft dysfunction in recipients of laparoscopically harvested kidneys.
10.1016/j.juro.2008.06.008
Direct visualization of renal hemodynamics affected by carbon dioxide-induced pneumoperitoneum.
Sassa Naoto,Hattori Ryohei,Yamamoto Tokunori,Kato Masashi,Komatsu Tomonori,Matsukawa Yoshihisa,Funahashi Yasuhito,Gotoh Momokazu
Urology
OBJECTIVES:To examine the direct renal hemodynamics during carbon dioxide pneumoperitoneum in both human and porcine models. Laparoscopic living donor nephrectomy has become widespread because of its minimally invasive nature. However, it has been clear that the renal hemodynamics and function are affected during carbon dioxide pneumoperitoneum. METHODS:The erythrocyte velocity in the cortical peritubular capillary (CPC) was monitored and measured during laparoscopic nephrectomy on human donors and laparoscopic partial nephrectomy on humans with renal cell carcinoma during carbon dioxide pneumoperitoneum (pressure of 8, 12, 15, 18, and 20 mm Hg). We used a direct imaging system of renal microcirculation by magnifying endoscopy, as previously described. We maintained the same pressure for 5 minutes. In the porcine model (6 pigs), we measured the erythrocyte velocity in the CPC using the same method during carbon dioxide pneumoperitoneum (pressure of 0, 5, 10, 15, 20, and 25 mm Hg). RESULTS:The erythrocyte velocity in the renal artery did not change during increased carbon dioxide pneumoperitoneum. When the pneumoperitoneal pressure was 25 mm Hg, we found that >90% of the erythrocyte velocity in the CPC was nonflowing. In the human model, the erythrocyte velocity in the CPC decreased when the carbon dioxide pneumoperitoneum pressure was 12 mm Hg. CONCLUSIONS:The erythrocyte velocity in the CPC decreased during carbon dioxide pneumoperitoneum in all kidneys in both the human and the porcine models. However, erythrocyte velocity in the renal artery did not change during carbon dioxide pneumoperitoneum. After stopping the pneumoperitoneum, the erythrocyte velocity in the CPC recovered immediately. The findings of our study have shown that the suitable carbon dioxide pneumoperitoneal pressure for renal microcirculation is <8 mm Hg for laparoscopic surgery.
10.1016/j.urology.2008.09.047
The effect of prolonged pneumoperitoneum on renal function in an animal model.
McDougall E M,Monk T G,Wolf J S,Hicks M,Clayman R V,Gardner S,Humphrey P A,Sharp T,Martin K
Journal of the American College of Surgeons
BACKGROUND:Prolonged, increased intra-abdominal pressure (IAP) during laparoscopic surgery has been associated with oliguria and anuria. STUDY DESIGN:The objective of this study was to evaluate the effects of various levels of IAP on renal function. Ten groups of three adult female farm pigs were given a general anesthetic, followed by establishment of an IAP of 0, 5, 10, 15, or 20 mm Hg with CO2, 20 mm Hg with argon gas, abdominal wall lift device, renal vein occlusion (RVO), 15 mm Hg with CO2 plus dopamine administration at 2 microgram/kg/minute, or 20 mm Hg retroperitoneal CO2 insufflation. The following studies were recorded: baseline central venous pressure (CVP), pulmonary wedge pressure (PWP), cardiac output (CO), renal vein flow (RVF), renal artery pressure (RAP), selective urine output (UO), urinary osmolarity, and creatinine clearance; the parameters were repeated every 30 minutes for the four hours of the IAP study and two hours after release of the IAP. RESULTS:The results were analyzed within two main IAP groups: less than 15 mm Hg and greater than or equal to 15 mm Hg. There was no clinically significant variation in the CVP, PWP, and RAP. The CO decreased slightly and this was more significant in the greater than or equal to 15 mm Hg group. The RVF and UO decreased concomitantly and significantly in the greater than or equal to 15 mm Hg group. Even after two hours of desufflation, the RVF did not return to baseline, although the UO improved. Creatinine clearance decreased significantly in the greater than or equal to 15 mm Hg group. The RVO group exhibited similar changes in the study parameters as those seen in the greater than or equal to 15 mm Hg group, although the RVF did not improve on release of the renal vein in the RVO group. Changes were the same with an argon or CO2 IAP of 20 mm Hg. The abdominal wall lift device had an associated decrease in RVF at 15 KG force but no alteration in UO. Retroperitoneal insufflation resulted in the same decrease in RVF and UO as seen with the same IAP. Dopamine did not afford a protective effect on UO during an IAP of 15 mm Hg. CONCLUSIONS:The decreased UO during prolonged IAP greater than or equal to 15 mm Hg in the animal model is associated with a corresponding decrease in RVF, but does not appear to be associated with any permanent renal derangement nor any transient histologic changes.
Results of hepatic and renal function tests to different CO2 pneumoperitoneum conditions: An experimental capnoperitoneum study in dogs.
Lee Jae Yeon,Choi Seok Hwa
Research in veterinary science
Carbon dioxide (CO2) is the most commonly used insufflation gas to provide exposure in the abdominal cavity during laparoscopic surgery. This study investigated the results of hepatic and renal function tests after different capnoperitoneum intraabdominal pressures in dogs. Twenty-four beagle dogs (12 males and 12 females) were used (n = 6 dogs). The intraabdominal pressure was maintained for 60 minutes, and urinalysis, hepatic and renal function tests were carried out at designed times. No surgery was performed on any of the dogs during the capnoperitoneum. In this study, whether low or high pressure, significant increases of gamma-glutamyltransferase, alkaline phosphatase, aspartate aminotransferase and creatinine levels were observed after pneumoperitoneum. However, our results showed a trend toward higher serum concentrations of some enzymes in dogs at an insufflation pressure of 15 mmHg compared to that of the other groups, although these differences did not reach statistical significance. Therefore, low pressure capnoperitoneum should be considered for dogs with compromised splanchnic function, particularly those undergoing prolonged laparoscopic surgery.
10.1016/j.rvsc.2015.04.014
Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study.
Aditianingsih Dita,Mochtar Chaidir Arif,Lydia Aida,Siregar Nuryati Chairani,Margyaningsih Nur Ita,Madjid Amir Sjarifuddin,Suwarto Suhendro
BMC anesthesiology
BACKGROUND:Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. METHODS:We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. RESULTS:The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. CONCLUSION:The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. TRIAL REGISTRATION:ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.
10.1186/s12871-020-0956-7
Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine.
Bishara Bishara,Karram Tony,Khatib Samer,Ramadan Rawi,Schwartz Henry,Hoffman Aaron,Abassi Zaid
Surgical endoscopy
BACKGROUND:Increased intra-abdominal pressure (IAP) (pneumoperitoneum) during laparoscopic surgery may result in adverse effects on kidney function. The mechanisms underlying this phenomenon have not been fully determined. OBJECTIVE:The present study was designed to: (1) investigate the effects of incremental increases in IAP on renal function in normal rats and (2) evaluate whether the nitric oxide (NO) system is involved in renal dysfunction characterizing pneumoperitoneum. METHODS:Male rats were organized into two groups. The first group was subjected to IAP of 0 (baseline), 7 or 14 mmHg, over 1 h for each pressure, followed by a deflation period of 60 min (recovery). Two additional groups were pretreated with: (1) non-depressor dose of nitroglycerine (NTG) and (2) nitro-L-arginine-methylester (L-NAME), an NO synthase inhibitor, before applying 14 mmHg for 1 h. Urine flow rate (V), Na+ excretion (U(Na)V), glomerular filtration rate (GFR), renal plasma flow (RPF), and blood pressure were determined throughout the experiments. RESULTS:There were no significant changes in V, U(Na)V, GFR, and RPF during 7 mmHg insufflation. However, significant reductions in these parameters were observed during 14 mmHg: V from 8.49 +/- 0.92 to 6.12 +/- 0.54 microl/min, U(Na)V from 1.29 +/- 0.28 to 0.39 +/- 0.09 microEq/min, and FE(Na) from 0.37 +/- 0.11 to 0.27 +/- 0.04%. These alterations in excretory functions were associated with a considerable decline in GFR from 1.85 +/- 0.09 to 0.88 +/- 0.09 ml/min, p < 0.05, (-46.3 +/- 5.2% from baseline) and RPF from 8.66 +/- 0.62 to 4.33 +/- 0.49 ml/min, p < 0.05, (-51.93 +/- 5.24% from baseline), without a significant change in mean arterial blood pressure (MAP). When the animals were pretreated with NTG, the adverse effects of pneumoperitoneum on V, U(Na)V, GFR, and RPF were substantially improved, suggesting that NO system plays a beneficial counter-regulatory role during laparoscopy. In line with this notion, pretreatment with L-NAME remarkably aggravated pneumoperitoneum-induced renal hypoperfusion and dysfunction. CONCLUSION:Decreased renal perfusion and function are induced by IAP pressure of 14 mmHg. These adverse effects are probably related to interference with the NO system, and could be partially ameliorated by pretreatment with NTG.
10.1007/s00464-008-9881-4
Pneumoperitoneum aggravates renal function in cases of decompensated but not compensated experimental congestive heart failure: role of nitric oxide.
Bishara Bishara,Abu-Saleh Niroz,Awad Hoda,Goltsman Ilia,Ramadan Rawi,Khamaysi Iyad,Abassi Zaid
The Journal of urology
PURPOSE:Congestive heart failure is associated with impaired renal function. Previously we noted that increased intra-abdominal pressure (pneumoperitoneum) in normal rats induced renal dysfunction. In this study we investigated the renal effects of pneumoperitoneum in rats with compensated (urinary Na(+) excretion greater than 1,200 μEq per 24 hours) and decompensated (urinary Na(+) excretion less than 200 μEq per 24 hours) congestive heart failure, and the possible involvement of nitric oxide in these effects. MATERIALS AND METHODS:After a baseline period rats with congestive heart failure induced by aorto-caval fistula and sham operated controls underwent consecutive intra-abdominal pressures of 7, 10 or 14 mm Hg for 45 minutes each. Urinary flow, urinary Na(+) excretion, glomerular filtration rate, renal plasma flow and urinary nitric oxide metabolites were determined. RESULTS:There were no changes in urinary flow, urinary Na(+) excretion, glomerular filtration rate or renal plasma flow during 7 mm Hg insufflation in controls. However, significant decreases in these parameters were observed during 10 and 14 mm Hg in correlation with intra-abdominal pressure. Baseline renal function and hemodynamics were lower in rats with congestive heart failure in correlation with disease severity. Rats with decompensated congestive heart failure that underwent 10 and 14 mm Hg showed aggravated decreases in urinary flow, urinary Na(+) excretion, glomerular filtration rate and renal plasma flow. In contrast, no adverse renal effects were observed in rats with compensated congestive heart failure under identical intra-abdominal pressure conditions. Despite unaltered baseline urinary nitric oxide metabolites in the 2 congestive heart failure subgroups, the decompensated group showed decreased urinary nitric oxide metabolites after 14 mm Hg. Finally, rats with compensated congestive heart failure pretreated with the nitric oxide synthase inhibitor L-NAME showed worse renal function in response to pneumoperitoneum. CONCLUSIONS:Decompensated congestive heart failure renders rats susceptible to the adverse renal effects of pneumoperitoneum, a phenomenon that may involve alterations in the renal nitric oxide system.
10.1016/j.juro.2011.03.040
Effect of Pneumoperitoneum on Renal Resistive Index and Renal Function in Patients Who Have Undergone Laparoscopic Living Donor Nephrectomy: A Pilot Study.
Ciko Prima,Widia Fina,Hamid Agus Rizal A H,Wahyudi Irfan,Mochtar Chaidir A
Transplantation proceedings
INTRODUCTION:The use of low-pressure pneumoperitoneum during laparoscopic living donor nephrectomy (LLDN) was assumed to cause less renal damage compared to high-pressure pneumoperitoneum. This study aims to evaluate the effect of low vs high-pressure pneumoperitoneum during LLDN on renal function and renal resistive index (RRI), which has never been done before. MATERIALS AND METHODS:The subjects were divided into 2 groups, low-pressure (8-10 mmHg) and high-pressure pneumoperitoneum (12-14 mmHg). The RRI, serum creatinine, and estimated glomerular filtration rate were measured during the perioperative period. RESULTS:A total of 45 samples were analyzed in this study: 17 subjects in the low-pressure pneumoperitoneum group and 28 subjects in the high-pressure group. RRI levels remained within the normal range (< .80) with no significant difference observed between the 2 groups (P > .05) before surgery, intraoperatively, or post-surgery. The preoperative and postoperative serum creatinine and glomerular filtration rate were similar in both groups. CONCLUSIONS:The use of low-pressure pneumoperitoneum had no benefit compared to high-pressure pneumoperitoneum in preserving RRI and function in LLDN.
10.1016/j.transproceed.2019.04.045
Effect of Pneumoperitoneum on Renal Function and Physiology in Patients Undergoing Robotic Renal Surgery.
Sodha Serena,Nazarian Scarlet,Adshead James M,Vasdev Nikhil,Mohan-S Gowrie
Current urology
Laparoscopic and minimally-invasive robotic access has transformed the delivery of urological surgery. While associated with numerous desirable outcomes including shorter post-operative stay and faster return to preoperative function, these techniques have also been associated with increased morbidity such as reduced renal blood flow and post-operative renal dysfunction. The mechanisms leading to these renal effects complex and multifactorial, and have not been fully elucidated. However they are likely to include direct effects from raised intra-abdominal pressure, and indirect effects secondary to carbon dioxide absorption, neuroendocrine factors and tissue damage from oxidative stress. This review summarises these factors, and highlights the need for further work in this area, to direct novel therapies and guide alterations in technique with the aim of reducing renal dysfunction post-laparoscopic and robotic surgery.
10.1159/000442842