Antidiuretic Hormone Release During Laparoscopic Donor Nephrectomy

Abstract

Background: During laparoscopic procedures, increased intra-abdominal pressure may cause transient renal dysfunction due to impaired renal blood flow and induction of neurohormones. However, the relationship between antidiuretic hormone (ADH) secretion and increased intra-abdominal pressure is poorly understood. Hypothesis: Laparoscopic donor nephrectomy (LDN) is associated with an increase in plasma ADH concentration, which influences renal function in both the donor and transplanted graft. Objectives: To evaluate plasma ADH levels during LDN and to correlate ADH levels with graft function. Design and Interventions: In 30 patients who underwent LDN, plasma ADH levels were collected before insufflation, during surgery, after desufflation, and 24 hours after the procedure. In 6 patients who had open donor nephrectomy, blood samples were obtained as controls. Furthermore, graft function, operative characteristics, and clinical outcome were compared. Setting: University hospital. Results: In the LDN group, mean ADH levels during pneumoperitoneum and 30 minutes postinsufflation were significantly higher compared with preinsufflation values (PϽ.001). Twenty-four hours after LDN, mean ADH levels had returned to normal values. There were no significant differences in ADH levels in the open donor nephrectomy group. No significant differences in either intraoperative diuresis, blood pressure readings, or postoperative graft function were documented among the 2 groups. Conclusions: In this study, LDN was associated with an increase in plasma ADH that appeared to be related to increased intra-abdominal pressure. We conclude that the increased ADH concentrations during LDN are not associated with clinically significant changes in either the kidney donor or the transplanted graft.

Laparoscopic surgery: Pitfalls due to anesthesia, positioning, and pneumoperitoneum

“…The following underlying mechanisms are considered: (1) compression of renal vasculature and parenchyma [63], (2) an increase of antidiuretic hormone release [64], (3) activation of the renin-angiotensin-aldosterone system (RAAS), and (4) a decrease of CO.…”

Acute Kidney Injury Induced by Various Pneumoperitoneum Pressures in a Rabbit Model of Mild and Severe Hydronephrosis

“…Several mechanisms contribute to acute renal injures in response to elevated intraabdominal pressure, such as reduced renal blood flow and cortical hypoperfusion [28], high excretion of antidiuretic hormone [29,30], and frequent respiratory acidosis, which induces the increased renal vasoconstriction of sympathetic stimuli [31]. Because severe hydronephrosis kidneys exhibited impaired tolerance to intraabdominal pressure in our study, we speculate that severe hydronephrosis kidneys are more sensitive to these mechanisms, and further study will be undertaken to explore these mechanisms in hydronephrosis kidneys.…”

Effects of different anesthetic techniques on antidiuretic hormone secretion during laparoscopic cholecystectomy

“…During laparoscopic procedures, increased intraabdominal pressure may cause transient renal dysfunction because of impaired renal blood flow and induction of neurohormones [10]. Appropriate intraoperative changes should be instituted to minimize these physiologic changes.…”