BACKGROUND Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. METHODS We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. RESULTS The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. CONCLUSION The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. TRIAL REGISTRATION ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.

中文翻译：

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低压与标准气压气腹对活体供肾者肾脏切除术中肾脏syndecan-1脱落和VEGF受体2表达的影响：一项随机对照研究。

背景技术腹腔镜肾切除术是用于活体肾脏捐赠的优选技术。然而，由于全身性炎症反应加剧，血管内皮发炎和肾小管细胞损伤，正压气腹对剩余的肾脏和其他远处器官可能产生不利影响。需要尽早发现血管内皮和肾小管反应，以防止由于气腹引起的腹腔内压力升高而进一步损害肾脏。经腹腔镜活体供体肾切除术代表了腹腔内压力轻度升高的人体模型。这项研究旨在通过比较低压和标准气压气腹对血管内皮生长因子受体2（VEGFR-2）表达和syndecan-1脱落的影响来评估腹腔高压对血​​管内皮和肾小管细胞的影响。全身性炎症的早期标志。方法我们对44例行腹腔镜供体肾切除术的患者进行了一项前瞻性随机研究。将受试者分为标准（12 mmHg）或低压（8 mmHg）组。通过ELISA定量基线，术中和术后血浆白细胞介素6，syndecan-1和sVEGFR-2。免疫组织化学方法在肾皮质组织中评估了Syndecan-1和VEGFR-2的表达。使用电子显微镜检查肾小管和肾小管周围的毛细血管超微结构。记录围手术期的血流动力学变化，潮气末二氧化碳，血清肌酐，血尿素氮和尿KIM-1。结果低压组的术中和术后心率，术中血浆IL-6，sVEGFR-2水平和血浆syndecan-1均低于标准压力组。低压组近端小管syndecan-1表达较高。低压组近端小管和肾小管周围毛细血管内皮细胞VEGFR-2表达较低。低压组显示肾小管和肾小管周围毛细血管超微结构，具有完整的细胞膜，清晰的细胞边界和完整的刷状边界，而标准压力组显示核肿，细胞膜薄弱，远处边界，空泡化和刷状边界分离。结论低压气腹减轻了炎症反应，并降低了因腹腔镜肾切除术中全身性炎症引起的肾小管和血管内皮促炎标记物syndecan-1脱落和VEGFR-2的表达。试验注册ClinicalTrials.gov NCT：03219398，预期于2017年7月17日注册。