Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Mediators of Regional Kidney Perfusion during Surgical Pneumoperitoneum Creation and the Risk of Acute Kidney Injury – A Review of Basic Physiology

Version 1 : Received: 15 April 2022 / Approved: 18 April 2022 / Online: 18 April 2022 (10:45:36 CEST)

A peer-reviewed article of this Preprint also exists.

Kopitkó, C.; Medve, L.; Gondos, T.; Soliman, K.M.M.; Fülöp, T. Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury—A Review of Basic Physiology. J. Clin. Med. 2022, 11, 2728. Kopitkó, C.; Medve, L.; Gondos, T.; Soliman, K.M.M.; Fülöp, T. Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury—A Review of Basic Physiology. J. Clin. Med. 2022, 11, 2728.

Journal reference: J. Clin. Med. 2022, 11, 2728
DOI: 10.3390/jcm11102728

Abstract

Acute kidney injury (AKI), especially if recurring represents a risk factor for future chronic kidney disease. In intensive care units, increased intraabdominal pressure is well-recognized as a significant contributor of AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumoperitoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumoperitoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumoperitoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.

Keywords

acute kidney injury; intra-abdominal pressure; oxidative stress; renal cortical blood flow; renal medullar blood flow; renal lymphatic drainage; venous congestion

Subject

MEDICINE & PHARMACOLOGY, General Medical Research

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