MP04-06 THE IMPACT OF PNEUMOPERITONEUM ON RENAL FUNCTION AND THE DEVELOPMENT OF ACUTE KIDNEY INJURY

Abstract

INTRODUCTION AND OBJECTIVE: Minimally invasive surgery is considered the gold standard approach for many urologic surgical procedures. However, it requires CO2 insufflation that causes elevated intra-abdominal pressure (IAP) and may result in adverse pulmonary, cardiovascular, gastrointestinal and renal changes. One of the main risk factors for developing post-operative acute kidney injury (AKI) is diabetes mellitus (DM). DM is considered an epidemic disease with rising incidence; hence the aim of this study was to examine whether the effect of pneumoperitoneum on renal function and the development of AKI is more pronounced in diabetic rats compared with normal rats. METHODS: Sprague Dawley rats were divided into two groups: Control (non-diabetic) rats (n=7) and diabetic rats (n=10). A Veress needle was used for CO2 inflation allowing the intra-abdominal pressure to be increased to desired levels of: 7, 10 and 14 mmHg for the duration of 45 minutes each. At the end, CO2 was deflated allowing pressure to decrease to 0 mmHg for 60 minutes (recovery phase). During each pressure point hemodynamic parameters were recorded and urine samples were collected for analysis of NGAL (neutrophil gelatinase associated lipocalin) a novel AKI biomarker. RESULTS: As shown in the Table, there were no statistically significant changes from baseline in urinary flow, urinary sodium excretion (UNaV), GFR, and RPF during 7 mmHg pressure in both groups. When the intra-abdominal pressure was further elevated, a significant deterioration of these parameters was recorded. This trend was more pronounced among the diabetic rats. When examining urinary NGAL, a linear correlation was observed between the intra-abdominal pressure and the biomarker level. This correlation was more significant in the diabetic group. CONCLUSIONS: The present study demonstrated a direct correlation between intra-abdominal pressure elevation and the development of AKI. Diabetic rats were more sensitive to the deleterious effect of pneumoperitoneum and urinary NGAL levels may be used as a future biomarker to predict post-operative AKI especially in diabetic patients.Source of Funding: None