Elevated Intra-abdominal Pressure and Renal Function

Harman, P. Kent; Krön, Irving L.; McLACHLAN, H.; Freedlender, Arthur E.; Nolan, Stanton P.

doi:10.1097/00000658-198211000-00015

Cited by 505 publications

(294 citation statements)

References 7 publications

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“…This aspect exposes the kidney parenchyma, the renal vessels, and the ureter to a risk of lesions [5,131. Secondly,experimental data are available that demonstrate that the increased intra-abdominal pressure of the pneumoperitoneum decreases renal blood flow, which diminishes glomerular filtration, and may provoke acute tubular necrosis [8,111. However, there is no clinical relevance of these findings so far, in terms of deleterious effects on the allograft.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and open live donor nephrectomy: a cost/benefit study

et al. 2000

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Recently, laparoscopic live-donor nephrectomy has been developed in order to increase organ donation. In this study we compare and review the records of 10 donors operated by open extraperitoneal approach and of 10 donors operated by a laparoscopic transperitoneal approach (LSC). Results show less use of postoperative parenteral narcotics in the LSC group (109 mg vs 272 mg; P < 0.0005) than in the extraperitoneal group. Morbidity was similar in both groups. There was no difference in postoperative stay. Allograft kidney function was similar in both groups until 6 months after donation. The use of disposable laparoscopic material bears an extra cost of 900 US$. We can thus conclude that laparoscopic live-donor nephrectomy is a safe procedure

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Section: Discussionmentioning

confidence: 99%

Laparoscopic and open live donor nephrectomy: a cost/benefit study

et al. 2000

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“…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).…”

mentioning

confidence: 99%

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

Abassi

Bishara²,

Karram³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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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...

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“…1 The disadvantages, however, are that the laparoscopic approach takes longer, 1 and the pressure exerted by the pneumoperitoneum on the donor kidney can diminish renal blood flow up to renal failure. 2 Some centres report a com-892 CANADIAN JOURNAL OF ANESTHESIA L parable morbidity and mortality of both approaches. 3 At the University of Washington Medical Center in Seattle, this case was the first in a series of 38 laparoscopic donor nephrectomies since 2000 which had to be converted to an open procedure.…”

Section: Objectif : Présenter Le Cas D'une Néphrectomie Laparoscopiqumentioning

confidence: 99%

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report

Martay

Dembo

Vater

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 59-yr-old man -height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I -presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive scarring surrounding the left kidney, adenopathy near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant blood loss, and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the patient made a full recovery.

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Elevated Intra-abdominal Pressure and Renal Function

Cited by 505 publications

References 7 publications

Laparoscopic and open live donor nephrectomy: a cost/benefit study

Laparoscopic and open live donor nephrectomy: a cost/benefit study

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

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report

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