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Pneumoperitoneum upregulates preproendothelin-1 messenger RNA
J A Ambrose1, R P Onders, N T Stowe
1Department of Surgery, Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Surgical Endoscopy
|April 5, 2001
Summary
Laparoscopic procedures decrease kidney function by increasing Endothelin-1 (ET-1). This study shows ET-1 upregulation in the kidney during pneumoperitoneum, suggesting ET-1 antagonism may protect renal function.
Area of Science:
- Nephrology
- Surgical Physiology
- Molecular Biology
Background:
- Laparoscopic pneumoperitoneum is associated with reduced glomerular filtration rate (GFR) and urine volume (UV).
- Endothelin-1 (ET-1), a potent renal vasoconstrictor, is a potential mediator of this renal dysfunction.
- Investigating ET-1's role is crucial for understanding and mitigating laparoscopic-induced kidney injury.
Purpose of the Study:
- To evaluate the impact of carbon dioxide (CO2) pneumoperitoneum on renal function.
- To determine the effect of pneumoperitoneum on ET-1 gene expression in the kidney.
- To localize the ET-1 peptide within renal tissues subjected to laparoscopic conditions.
Main Methods:
- Experiments were conducted on anesthetized Sprague-Dawley rats divided into three groups: pneumoperitoneum, sham operation, and normal control.
- Glomerular filtration rate (GFR) and urine volume (UV) were measured before, during, and after insufflation.
- Kidney tissue was analyzed for preproET-1 (ppET-1) mRNA levels using reverse transcription-polymerase chain reaction (RT-PCR) and for ET-1 peptide localization via immunohistochemistry (IHC).
Main Results:
- Pneumoperitoneum significantly decreased GFR by 87% and UV by 79%, with values returning to baseline post-desufflation.
- RT-PCR revealed a significant increase in ppET-1 mRNA expression in the laparoscopic group compared to control and sham groups.
- IHC demonstrated enhanced ET-1 peptide expression in the vascular endothelium and proximal tubular cells of kidneys from the laparoscopic group.
Conclusions:
- Pneumoperitoneum leads to increased ET-1 gene and peptide expression in the kidney.
- Elevated ET-1 levels, particularly in renal vasculature and proximal tubules, may contribute to observed renal dysfunction.
- Targeting ET-1 could offer a therapeutic strategy to protect kidney function during prolonged laparoscopic procedures or in allograft transplantation.