Adverse effects of pneumoperitoneum on renal function: involvement of the endothelin and nitric oxide systems

Abstract

The mechanism underlying this phenomenon is largely unknown. This study was designed to investigate the involvement of endothelin (ET)-1 and nitric oxide (NO) systems in IAP-induced renal dysfunction. Rats were subjected to IAP of 14 mmHg for 1 h, followed by a deflation for 60 min (recovery). Four additional groups were pretreated with 1) ABT-627, an ET A antagonist; 2) A-192621, an ETB antagonist; 3) nitroglycerine; and 4) N G -nitro-L-arginine methyl ester, a NO synthase inhibitor, before IAP. Urine flow rate (V), absolute Na ϩ excretion (UNaV), glomerular filtration rate (GFR), and renal plasma flow (RPF) were determined. Significant reductions in kidney function and hemodynamics were observed when IAP was applied. V decreased from 8.1 Ϯ 1.0 to 5.8 Ϯ 0.5 l/min, UNaV from 1.08 Ϯ 0.31 to 0.43 Ϯ 0.10 eq/min, GFR from 1.84 Ϯ 0.12 to 1.05 Ϯ 0.06 ml/min (Ϫ46.9 Ϯ 2.7% from baseline), and RPF from 8.62 Ϯ 0.87 to 3.82 Ϯ 0.16 ml/min (Ϫ54 Ϯ 3.5% from baseline). When the animals were pretreated with either ABT-627 or A-192621, given alone or combined, the adverse effects of IAP on GFR, RPF, V, and UNaV were significantly augmented. When the animals were pretreated with nitroglycerine, the adverse effects of pneumoperitoneum on GFR and RPF were substantially improved. In contrast, pretreatment with N G -nitro-L-arginine methyl ester remarkably aggravated pneumoperitoneum-induced renal dysfunction. In conclusion, decreased renal excretory function and hypofiltration are induced by increased IAP. These effects are related to impairment of renal hemodynamics and could be partially ameliorated by pretreatment with nitroglycerine and aggravated by NO and ET blockade.rat; intra-abdominal pressure PNEUMOPERITONEUM AT PRESSURE above 10 mmHg during laparoscopic surgery has been shown to produce transient oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF) (3,9,16,33,34). Despite much research in this field, the systemic physiological consequences of CO 2 pneumoperitoneum and the mechanisms underlying its adverse effects on renal hemodynamics and excretory function are not fully understood (9). However, there is compelling experimental evidence that the adverse renal effects induced by pneumoperitoneum are affected by the level of intra-abdominal pressure (IAP), volume status, degree of hypercarbia, positioning, and individual hemodynamic and renal reserves (9, 10). Additional factors that may affect renal function during pneumoperitoneum include direct compression of the renal parenchyma and renal vein (4, 17), increased resistance in the renal vasculature (47), and release of vasoconstrictors, such as vasopressin, angiotensin II, catecholamines, and endothelin (ET)-1 (1, 13). The latter is a very potent natural mammalian vasoconstrictor agent (25), acting on the cardiovascular and renal systems and other target organs by binding to two major types of receptors, ET A and ET B (2,25,36). High abundance of ET A receptors has been detected in the aorta, heart, and kidney, whereas ET B receptors are expre...

Anästhesie bei laparoskopischen Eingriffen

“…In Tierversuchen zeigte sich des Weiteren eine Interaktion mit dem Stickstoffmonoxid-(NO-) und Endothelinsystem. Die negativen Effekte konnten durch eine Vorbehandlung der Tiere mit Nitroglyzerin vermindert werden [8]. Auch an der Leber kommt es zu einem verminderten Blutfluss, der sich in einer subklinischen hepatischen Dysfunktion mit um bis zu 100% gestiegenen Transaminasewerten widerspiegelt [9].…”

Impact of Pneumoperitoneum on the Post-Operative Renal Function and Level of Acute Kidney Injury Markers: Comparison between Laparoscopic and Open Nephrectomy

“…Determination of urinary NGAL and KIM-1: NGAL and KIM-1 were determined from a single 10 µl specimen of urine and were measured with commercially available ELISA kits (NGAL Rapid ELISA Kit; Bio Porto Diagnostics, Gentofte, Denmark) and (Wuhan EIAab Scitween pneumoperitoneum and kidney injury in rat model [5]. Others reported similar results in human [6,7].…”

“…This is particularly important in cases of laparoscopic nephrectomy, because maintaining the function of the remnant kidney is critical. Increased intra-abdominal pressure associated with pneumoperitoneum leads to compression of the kidney parenchyma, reduced cardiac output and systemic hormonal effects, which result in decreased Glomerular Filtration Rate (GFR) and urinary output [1][2][3][4][5]. In a review of five animal studies, Shafer, et al demonstrated a decrease in renal perfusion ranged from 12% to 14% [14].…”

Nitric oxide synthase inhibition aggravates the adverse renal effects of high but not low intraabdominal pressure

“…The rats were prepared for clearance studies, as described earlier [30,31]. After a 60-min equilibration period, two baseline clearance periods of 30 min each were obtained (IAP = 0).…”

“…However, the involvement of the NO system in the adverse effects of pneumoperitoneum on renal perfusion and function has not yet been explored. For this purpose, we recently investigated the involvement of NO in pneumoperitoneum-induced renal dysfunction in rats [30,31].…”