Table of Contents
Advances in Nephrology
Volume 2014 (2014), Article ID 731657, 15 pages
http://dx.doi.org/10.1155/2014/731657
Review Article

Deleterious Effects of Increased Intra-Abdominal Pressure on Kidney Function

1Department of Nephrology, The Nazareth Hospital-EMMS, Nazareth, Israel
2Galilee Medical School, Bar Ilan University, Safed, Israel
3Research Unit, Rambam Health Care Campus, Haifa, Israel
4Department of Physiology & Biophysics, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, P.O. Box 9649, 31096 Haifa, Israel

Received 18 June 2014; Revised 9 October 2014; Accepted 9 October 2014; Published 12 November 2014

Academic Editor: Dewan S. Abdul Majid

Copyright © 2014 Zaher Armaly and Zaid Abassi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Elevated intra-abdominal pressure (IAP) occurs in many clinical settings, including sepsis, severe acute pancreatitis, acute decompensated heart failure, hepatorenal syndrome, resuscitation with large volume, mechanical ventilation with high intrathoracic pressure, major burns, and acidosis. Although increased IAP affects several vital organs, the kidney is very susceptible to the adverse effects of elevated IAP. Kidney dysfunction is among the earliest physiological consequences of increased IAP. In the last two decades, laparoscopic surgery is rapidly replacing the open approach in many areas of surgery. Although it is superior at many aspects, laparoscopic surgery involves elevation of IAP, due to abdominal insufflation with carbonic dioxide (pneumoperitoneum). The latter has been shown to cause several deleterious effects where the most recognized one is impairment of kidney function as expressed by oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF). Despite much research in this field, the systemic physiologic consequences of elevated IAP of various etiologies and the mechanisms underlying its adverse effects on kidney excretory function and renal hemodynamics are not fully understood. The current review summarizes the reported adverse renal effects of increased IAP in edematous clinical settings and during laparoscopic surgery. In addition, it provides new insights into potential mechanisms underlying this phenomenon and therapeutic approaches to encounter renal complications of elevated IAP.