Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function

Lars J. Cisek, Rita M. Gobet, Craig A Peters

Research output: Contribution to journalArticle

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Abstract

Laparoscopic surgery with intraperitoneal insufflation is associated with acute oliguria. Although in healthy patients, this impairment is transient and without any apparent sequelae, as the scope of laparoscopic surgery expands, subtle renal injury may become clinically significant, particularly when applications expand to patients with reduced baseline renal function. We have investigated the changes in renal function during and after pneumoperitoneum in animals with reduced renal mass to identify both acute alterations and long-term impairments, if any. Twelve swine underwent surgical reduction in renal mass to produce chronic renal insufficiency. Glomerular filtation rate (GFR) was determined by inulin clearance for each animal before and after ablation to establish the degree of renal impairment (mean 22%; range 18%-31% of normal). The animals were followed during a stepwise insufflation as a study of pneumoperitoneum-induced changes in chronic renal failure. Urine output declined dramatically (-80% at 20 mm Hg), the GFR fell (-63% at 20 mm Hg), and renal blood flow declined (mean -12%; range -9% to -19%) over the course of the test. These values did not return to baseline during a 90-minute observation period after release of the pneumoperitoneum. Acute renal failure occurred despite aggressive hydration with maintenance of central venous pressure and only modest changes in cardiac output. The animals were exposed to a 6-hour CO2 pneumoperitoneum to 20 mm Hg to model the insult of complex laparoscopy. This exposure resulted in elevation of the amount of N-methyl-β-D-glucosaminidase being shed into the urine in addition to the previously indicated impairments. The animals were allowed to recover for 1 week, and then GFR was again measured. The GFR returned to the preexposure chronic renal failure levels for both the group as a whole and individual animals. The magnitude and duration of the alteration in urine output, GFR, and renal blood flow suggest that regulatory mechanisms rather than simple mechanical forces are involved in the acute changes. No long-term impact on renal function from the acute renal injury was identified, even in animals with existing renal insufficiency.

Original languageEnglish (US)
Pages (from-to)95-100
Number of pages6
JournalJournal of Endourology
Volume12
Issue number2
DOIs
StatePublished - Jan 1 1998

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Pneumoperitoneum
Kidney
Laparoscopy
Insufflation
Renal Circulation
Urine
Acute Kidney Injury
Chronic Kidney Failure
Oliguria
Hexosaminidases
Central Venous Pressure
Inulin
Chronic Renal Insufficiency
Cardiac Output
Renal Insufficiency
Swine
Maintenance
Observation
Wounds and Injuries

ASJC Scopus subject areas

  • Urology

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Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function. / Cisek, Lars J.; Gobet, Rita M.; Peters, Craig A.

In: Journal of Endourology, Vol. 12, No. 2, 01.01.1998, p. 95-100.

Research output: Contribution to journalArticle

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abstract = "Laparoscopic surgery with intraperitoneal insufflation is associated with acute oliguria. Although in healthy patients, this impairment is transient and without any apparent sequelae, as the scope of laparoscopic surgery expands, subtle renal injury may become clinically significant, particularly when applications expand to patients with reduced baseline renal function. We have investigated the changes in renal function during and after pneumoperitoneum in animals with reduced renal mass to identify both acute alterations and long-term impairments, if any. Twelve swine underwent surgical reduction in renal mass to produce chronic renal insufficiency. Glomerular filtation rate (GFR) was determined by inulin clearance for each animal before and after ablation to establish the degree of renal impairment (mean 22{\%}; range 18{\%}-31{\%} of normal). The animals were followed during a stepwise insufflation as a study of pneumoperitoneum-induced changes in chronic renal failure. Urine output declined dramatically (-80{\%} at 20 mm Hg), the GFR fell (-63{\%} at 20 mm Hg), and renal blood flow declined (mean -12{\%}; range -9{\%} to -19{\%}) over the course of the test. These values did not return to baseline during a 90-minute observation period after release of the pneumoperitoneum. Acute renal failure occurred despite aggressive hydration with maintenance of central venous pressure and only modest changes in cardiac output. The animals were exposed to a 6-hour CO2 pneumoperitoneum to 20 mm Hg to model the insult of complex laparoscopy. This exposure resulted in elevation of the amount of N-methyl-β-D-glucosaminidase being shed into the urine in addition to the previously indicated impairments. The animals were allowed to recover for 1 week, and then GFR was again measured. The GFR returned to the preexposure chronic renal failure levels for both the group as a whole and individual animals. The magnitude and duration of the alteration in urine output, GFR, and renal blood flow suggest that regulatory mechanisms rather than simple mechanical forces are involved in the acute changes. No long-term impact on renal function from the acute renal injury was identified, even in animals with existing renal insufficiency.",
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