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This Article Full Text Full Text (PDF) All Versions of this Article: 294/3/R842    most recent 00691.2007v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abassi, Z. Articles by Hoffman, A. Search for Related Content PubMed PubMed Citation Articles by Abassi, Z. Articles by Hoffman, A.

RENAL HEMODYNAMICS AND CARDIORENAL INTEGRATION

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

¹Department of Physiology and Biophysics, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, and ²Department of Vascular Surgery and Kidney Transplantation, ³Department of General Surgery "A", and ⁴Department of Anesthesiology, Rambam Human Health Care Campus, Haifa, Israel

Submitted 25 September 2007 ; accepted in final form 22 December 2007

Increased intra-abdominal pressure (IAP) during laparoscopy adversely affects kidney function. 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 ET_B antagonist; 3) nitroglycerine; and 4) N^G-nitro-L-arginine methyl ester, a NO synthase inhibitor, before IAP. Urine flow rate (V), absolute Na⁺ excretion (U_NaV), 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 ± 1.0 to 5.8 ± 0.5 µl/min, U_NaV from 1.08 ± 0.31 to 0.43 ± 0.10 µeq/min, GFR from 1.84 ± 0.12 to 1.05 ± 0.06 ml/min (–46.9 ± 2.7% from baseline), and RPF from 8.62 ± 0.87 to 3.82 ± 0.16 ml/min (–54 ± 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 U_NaV 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