A human model of intra-abdominal hypertension: even slightly elevated pressures lead to increased acute systemic inflammation and signs of acute kidney injury
© BioMed Central Ltd 2013
Published: 4 April 2013
Intra-abdominal hypertension (IAH) may have catastrophic effects on critically ill patients, but its pathophysiology is only partially understood . Oliguria and renal dysfunction are among the earliest signs of increasing intra-abdominal pressure (IAP) . A number of different pathophysiological mechanisms may be responsible . One of these may be an increase in pro-inflammatory cytokines provoked by IAH . In IAPs of greater than 20 mm Hg, an increase in circulating levels of a variety of inflammatory mediators has been described .
We analyzed markers of inflammation and renal function in a prospective randomized clinical trial. In this trial, 50 living kidney donors were randomly assigned between hand-assisted laparoscopy by a transperitoneal approach and open nephrectomy by a retroperitoneal approach . In this human model of IAH, a carbon dioxide pneumo-peritoneum of 12 mm Hg was induced during the procedure in the laparoscopic group. The open nephrectomy group served as a control group, and IAH was not applied.
Although procedure time is shorter , laparoscopic nephrectomy leads to increased inflammation and signs of renal injury. It is tempting to hypothesize that even mild IAH leads to mildly increased systemic inflammation and increased plasma NGAL as a sign of acute kidney injury in this group. Other factors such as operative technique or inflammation caused by carbon dioxide gas may contribute. Further studies to dissect the contributions of inflammation, hemodynamics, and local pressure effects on renal injury in IAH are warranted.
neutrophil gelatinase-associated lipocalin.
The study was approved by the Medical Ethical Review Board of the University Medical Center Groningen and conducted in accordance with the principles of the 2000 Declaration of Helsinki. The trial was registered at ClinicalTrials.gov (NCT00258986). Informed consent for participation and for publication was obtained from all patients before inclusion.
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