Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

Abstract

PURPOSE:To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS:Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS:The CO 2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO 2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS:The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO 2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.

Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury—A Review of Basic Physiology

“…The reduction of RPF was much more noticeable when IAP raised to 14 mmHg, but it became independent from the length of the insufflation interval [ 21 ]. These effects were less marked when, instead of CO 2 , helium or argon was insufflated intra-peritoneally [ 51 , 52 , 53 , 54 , 55 ].…”

Mediators of Regional Kidney Perfusion during Surgical Pneumoperitoneum Creation and the Risk of Acute Kidney Injury – A Review of Basic Physiology

“…21 These effects were less marked when, instead of CO2, helium or argon was insufflated intraperitoneally. [50][51][52][53][54] Further insights can be obtained from porcine models by examining the differences in flow dynamics between the medulla and the cortex upon increased intra-abdominal pressure. In a porcine model, the initial renal cortical blood flow was 5.5 times greater (50 ±18 vs 9 ±3 mL×min -1 ×100 g -1 [tissue]) than the medullary blood flow once the abdomen was insufflated and a laser-Doppler flowmetry probe was introduced into the renal parenchyma.…”

Protective effect of theophylline on renal functions in experimental pneumoperitoneum model

“…In another study, moderate hydropic degeneration and congestion were observed in both kidneys between the control group and the group where pneumoperitoneum was performed in the histopathological examination, but no significant difference detected. 27 In another study, however, in the histopathological examination of kidneys received from the rats, pathologic data varying from minimal alterations to moderate Acute tubular necrosis (ATN) in kidneys were obtained proportionally to increasing pressures. 7 When these results were considered, it could be thought that histopathological alterations occurring in kidneys change depending upon the duration to form pneumoperitoneum and the pressure of pneumoperitoneum formed.…”