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Purpose: As laparoscopic surgery becomes more widespread, understanding the adverse effects of pneumoperitoneum becomes more important, especially in patients subjected to laparoscopic unilateral nephrectomy. The purpose of the current study was to investigate the effect of pneumoperitoneum on the remnant kidney after laparoscopic nephrectomy compared to open surgery. Methods: The study group included 30 patients. 22 patients underwent laparoscopic nephrectomy whereas 8 patients underwent open nephrectomy. Serum and urine samples were collected before surgery, 8 and 24 hours after surgery. At these time points’ urine levels of NGAL and KIM-1, two novel biomarkers for acute kidney injury (AKI) were also determined. Results: Following surgery serum creatinine slightly increased in both groups but then decreased in those who had open procedure compared with the laparoscopic cases where it continued to increase. Urinary NGAL, but not urinary KIM-1, increased in both groups after 8 and 24 hours. The pattern of change of both urinary markers (NAGL and kim-1) after surgery was not affected by the use of pneumoperitoneum compared to the open procedure. More patients in the laparoscopic group developed acute kidney injury (41% vs. 12%). Conclusions: The present study shows a negative effect of pneumoperitoneum on the kidney function in patients undergoing laparoscopic nephrectomy compared to the open procedure. NGAL and KIM-1 urinary levels were not affected by the increased intra-abdominal pressure.

international archives of urology and complications

Impact of Pneumoperitoneum on the Post-Operative Renal Function and Level of Acute Kidney Injury Markers: Comparison between Laparoscopic and Open Nephrectomy