Effects of Carbon Dioxide Pneumoperitoneum on Renal Function in Obstructive Jaundice: an Experimental Study in a Rat Model

Abstract

Introduction: Both pneumoperitoneum (PNP) and obstructive jaundice (OJ) are known to lead to acute kidney injury (AKI) potentially, but the combined effect has not been investigated. Aim: This study aimed to investigate the effects of PNP on renal functions in a rat model of OJ. Methods: We divided forty-eight rats into eight groups of six rats. Group 1 was the control (sham-operated) group; Groups 2, 3, and 4 were induced 5, 10, and 15 mmHg of CO2 PNP, respectively (Groups 1-4: "non-OJ Groups"); Group 5 was the OJ group; and Groups 6, 7 and 8 were OJ groups that were induced with 5, 10, and 15 mmHg CO2 PNP was respectively (Groups 5-8: "OJ Groups"). The common bile duct was ligated and divided into OJ Groups. After 48 hours, a 5-10-15 mmHg PNP was induced by mini-laparotomy with a Veress needle in Groups 6, 7, and 8, maintained for 60 minutes. Results: There were no statistically significant differences between groups regarding blood urea Nitrogen and Creatinin levels (p> 0.05). Neutrophil gelatinase-associated lipocalin (NGAL) values were significantly higher in OJ Groups than in non-OJ Groups (p< 0.05). Serum Cystatin-C values were significantly higher in OJ Groups with 10 and 15 mmHg PNP than in nonOJ Groups (p< 0.05). Conclusion: In the early stage of AKI, NGAL and Cystatin-C levels might be higher, while standard renal function tests were normal. Our findings highlight the apparent unfavorable effect of OJ with PNP on renal functions and early recognition of AKI with the measurement of NGAL and Cystatin-C in these conditions.