Cytokine elevation and transaminitis after laparoscopic donor nephrectomy

Abstract

Yap S, Park SW, Egan B, Lee HT. Cytokine elevation and transaminitis after laparoscopic donor nephrectomy. Am J Physiol Renal Physiol 302: F1104 -F1111, 2012. First published January 18, 2012 doi:10.1152/ajprenal.00543.2011.-Acute kidney injury frequently occurs in the critically ill and often progresses into multiorgan dysfunction syndrome, resulting in high mortality. We previously showed that nephrectomized mice had increased interleukin (IL)-6 and tumor necrosis factor (TNF)-␣ that directly contributed to systemic inflammation and hepatic injury. In this study, we examined whether patients undergoing laparoscopic donor nephrectomy have increased postoperative cytokine levels with injury to the liver and whether the remaining kidney sustains injury. Serial serum and urine samples were collected from 32 patients undergoing laparoscopic donor nephrectomy and 17 patients undergoing nonrenal laparoscopic surgery. Serum IL-6, IL-18, TNF-␣ and monocyte chemotactic protein-1 (MCP-1) (markers of systemic inflammation) and urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), MCP-1, and IL-18 (markers of acute kidney injury) were quantified by enzyme-linked immunosorbent assay. We also analyzed serum creatinine, aspartate transaminase (AST), and alanine transaminase to assess liver injury. Patients who underwent donor nephrectomy not only demonstrated increased serum creatinine but also had significant increases in serum IL-6, MCP-1, and AST. Serum TNF-␣ also trended upward in donor nephrectomy patients. Finally, the donor nephrectomy group showed increased urinary NGAL but not KIM-1 at 24 h. Taken together, our findings of increased serum IL-6, MCP-1, and AST after donor nephrectomy suggest that an acute reduction of kidney function induces systemic inflammation and may have distant effects on the liver. Further studies are needed to correlate increased urinary NGAL after donor nephrectomy both as a potential marker for renal tubular stress and/or hypertrophy in the contralateral kidney.acute kidney injury; interleukin-6; neutrophil gelatinase-associated lipocalin; tumor necrosis factor-␣ ACUTE KIDNEY INJURY (AKI) is a frequent occurrence in the critically ill with 5% to 20% of patients experiencing an episode of AKI during their intensive care unit stay (46). Mortality in critically ill patients with AKI remains high and is estimated to be Ͼ50% (54). Even when controlled for the severity of illness, AKI confers an independent risk for mortality regardless of whether AKI is mild or treated with renal replacement therapy (30). Hence, understanding the specific extrarenal effects of AKI in propagating or exacerbating multiorgan dysfunction is essential, since it may lead to new therapies in decreasing mortality after AKI.In animal models, it is increasingly clear that AKI is not an isolated event and induces distant organ dysfunction to the lungs, heart, liver, and brain through a mechanism that involves neutrophil migration and elevated cytokine levels (14).In particular, hepat...

Urine Neutrophil Gelatinase-Associated Lipocalin as a Marker of Acute Kidney Injury After Kidney Surgery

“…Yap 24 did not demonstrate an elevated uNGAL before 24hrs in their study of donor nephrectomy patients, though the only previous sample was at 5hrs post op. In that study, as in ours, mean NGAL did not reach AKI levels (150ng/ml) even at 24 hrs.…”

“…The high rate of AKI in the RN group, as calculated by AKIN criteria (which allows for a rise in sCr within 48 hours after injury), has been seen in up to 75% of patients in other studies. 24 …”

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

“…Unfortunately, there are very small number of human studies in the literature addressing this important topic. One study investigated the effect of pneumoperitoneum after laparoscopic donor nephrectomy [8]. However, donor patients were healthy and rigorously screened for preexisting comorbidities and the patients were not compared to open procedure.…”

Prospective assessment of urinary neutrophil gelatinase‐associated lipoprotein in living kidney donors: toward understanding differences between chronic kidney diseases of surgical and medical origin

“…Therefore, many studies reporting changes in NGAL with acute kidney injury, kidney surgery, or renal ischaemia–reperfusion injury have analysed urinary NGAL (uNGAL) rather than (or in addition to) sNGAL . Several observational studies have evaluated uNGAL in kidney donors, but none have definitively reported how uNGAL relates to renal function of the living kidney donor . Therefore, we conducted the present prospective study to assess clinical implications of uNGAL in living kidney donation.…”