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

Shalabi, Amjad

doi:10.23937/2469-5742/1510026

Cited by 5 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The association between renal function and pneumoperitoneum was demonstrated in previous studies, where the increased abdominal pressure caused compression of the renal parenchyma, decreased cardiac output, and alterations in hormone release that regulate GFR. 2,19,20 Ozmen et al 21 have also shown that elevated IAP is responsible for ischemia, free radical production, and proinflammatory cytokine response-mediated cell damage during laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1 The kidneys are sensitive to increased IAP and several studies that examined the effects of pneumoperitoneum on renal function explicitly demonstrated a higher incidence of acute kidney injury (AKI) in minimally invasive surgeries as compared with the open approach. 2,3 This phenomenon was attributed to the deleterious effects of pneumoperitoneum, which causes compression of renal vessels and parenchyma, activation of antidiuretic hormone, increasing renin-angiotensinaldosterone system activity, and compression of the vena cava that results in decreased cardiac output. 2,3 AKI is a common clinical condition that affects up to 20% of hospitalized patients.…”

mentioning

confidence: 99%

“…2,3 This phenomenon was attributed to the deleterious effects of pneumoperitoneum, which causes compression of renal vessels and parenchyma, activation of antidiuretic hormone, increasing renin-angiotensinaldosterone system activity, and compression of the vena cava that results in decreased cardiac output. 2,3 AKI is a common clinical condition that affects up to 20% of hospitalized patients. [4][5][6][7] The main risk factors for the development of AKI include severe infections, dehydration, older age, chronic kidney disease, and diabetes mellitus (DM).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of Pneumoperitoneum on the Development of Acute Kidney Injury: Comparison Between Normal and Diabetic Rats

Abboud¹,

Bishara²,

Nativ

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Minimally invasive surgery is considered the goldstandard approach for many surgical procedures. However, it requires CO 2 insufflation and elevated intra-abdominal pressure (IAP), which may result in adverse pulmonary, cardiovascular, gastrointestinal, and renal changes. The kidneys are highly sensitive to pressure changes, where risk factors such as severe infection, dehydration, older age, and chronic kidney disease may aggravate the likelihood for the development of acute kidney injury (AKI). Unfortunately, the impact of diabetes mellitus on the deleterious effects of elevated IAP-induced AKI was not fully studied so far. The present study was designed to examine the effect of pneumoperitoneum on renal function and the development of AKI in diabetic rats.Materials and Methods: Sprague Dawley rats were divided into 2 groups: control (nondiabetic) rats (n = 7) and diabetic rats (n = 10). A Veress needle was introduced through the supravesical incision where inflating CO 2 allowing the IAP to be increased to the desired pressures 7, 10, and 14 mm Hg for 45 minutes each and at the end of the experiment, the pressure was deflated to zero. During each pressure point, hemodynamic parameters were recorded and urine and blood samples were collected for analysis. Results:The baseline values of renal hemodynamic were significantly lower in diabetic rats. There were no major statistically significant changes from baseline in urinary flow, urinary sodium excretion (UNaV), glomerular filtration rate, and renal plasma flow during 7 mm Hg pressure in both groups. When the IAP was further elevated, a significant deterioration of these parameters was recorded. This trend was more pronounced among diabetic rats. When examining urinary neutrophil gelatinase-associated lipocalin, a linear correlation was observed between the IAP and the biomarker level. This correlation was more significant in the diabetic group. Conclusion:The present study demonstrated a direct correlation between IAP elevation and the development of AKI. Diabetic rats were more sensitive to the deleterious effect of pneumoperitoneum, where urinary neutrophil gelatinase-associated lipocalin levels may be used as a future biomarker to predict postoperative AKI, especially in patients with diabetes.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Impact of Pneumoperitoneum on the Development of Acute Kidney Injury: Comparison Between Normal and Diabetic Rats

Abboud¹,

Bishara²,

Nativ

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…4 Because the number of functioning nephron units has been reduced, the creatinine-based criteria were not easily applicable and the deterioration of renal function was defined by increased levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). 4 The diagnosis of worsening of renal function or AKI is based on the change of creatinine, or biomarkers and urine output. A temporary clamping of at least secondary branches of renal artery or of the whole renal pedicle may be required during partial nephrectomy to limit intraoperative blood loss.…”

Section: Clinical Studies Comparing the Open And Laparoscopic Approachesmentioning

confidence: 99%

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

et al. 2022

View full text Add to dashboard Cite

An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.

show abstract

“…Patients with postoperative acute kidney injury (AKI) show significantly inferior survival rates compared to patients with normal kidney function [ 1 ]. Moreover, recurrent AKI represents a risk factor for future decline of kidney function [ 2 , 3 , 4 ] The incidence of AKI falls between 2 and 41% after major intra-abdominal surgery, depending on the type of surgery and the criteria employed for the diagnosis of AKI [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Kopitkó

Medve

Gyökeres

et al. 2022

JCM

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 5 publications

References 20 publications

Impact of Pneumoperitoneum on the Development of Acute Kidney Injury: Comparison Between Normal and Diabetic Rats

Impact of Pneumoperitoneum on the Development of Acute Kidney Injury: Comparison Between Normal and Diabetic Rats

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

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

Contact Info

Product

Resources

About