The Effect Of Pneumoperitoneum Preconditioning And Renal Artery Occlusion Preconditioning On Renal Ischemiareperfusion Injury In Rats With Solitary Kidney

ObjectiveTo evaluate the effect of ischemic preconditioning(IPC)by 15 mmHg pneumoperitoneum preconditioning(PP) and renal artery occlusion preconditioning(AOP) on renal ischemia-reperfusion injury in rats with solitary kidney.MethodForty healthy male Wistar rats of clean grade were removed of right kidney to establish the models of solitary kidney rats.Rehabilitation after feeding for 2 weeks,the rats were randomly divided into four groups:sham operation group(sham group, n=10), ischemia reperfusion group(I/R group, n=10),15 mm Hg pneumoperitoneum preconditioning group(PP group, n=10)and renal artery occlusion preconditioning group(AOP group,n=10). In sham group left renal artery was only isolated without occluding.Renal artery was directly occluded for 45 min in I/R group, In PP group left renal ischemia for 45 minutes was produced by occluding renal artery after 15 mm Hg pneumoperitoneum preconditioning twice(deflate 10min/inflatate 10min), In AOP group before left renal ischemia for 45 minutes was induced with left renal artery occlusion, renal artery preconditioning twice(artery ischemia 10min/ reperfusion 10min)was performed in the open state. After reperfusion for 24 h, the blood samples were collected by Vacuum blood taking needle from abdominal aorta in all rats,serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) were measured. After left kidney was resected,the content of malondialdehyde(MDA) in kidney tissue was measured.Results1.After reperfusion for 24 h, group I/R compared with Sham group, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration increased significantly(119.7±42.96 vs 39.5±6.96,27.84±9.19 vs 6.98±1.34,23517.72±4404.88 vs 6420.90±1942.04,384.67±57.57 vs 201.23±32.04,all P<0.001). 2.After reperfusion for 24 h, PP group compared with Sham group, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration increased significantly(61.0±4.08 vs 39.5±6.96,11.62±1.27 vs 6.98±1.34,19590.53±3556.99 vs 6420.90±1942.04,270.91±36.07 vs 201.23±32.04,all P<0.001). 3.After reperfusion for 24 h,AOP group compared with Sham group, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration increased significantly(63.8±7.47 vs 39.5±6.96,11.91±3.31 vs 6.98±1.34, 18498.22±2949.62 vs 6420.90±1942.04,270.78±27.95 vs 201.23±32.04,all P<0.001). 4.After reperfusion for 24 h,PP group compared with I/R group, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration decreased significantly(61.0±4.08 vs119.7±42.96,11.62±1.27 vs27.84±9.19,19590.53±3556.99 vs 23517.72±4404.88,270.91±36.07 vs 384.67±57.57,all P<0.01). 5.After reperfusion for 24 h,AOP group compared with I/R group, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration decreased significantly(63.8±7.47 vs119.7±42.96,11.91±3.31 vs27.84±9.19,18498.22±2949.62 vs 23517.72±4404.88,270.78±27.95 vs 384.67±57.57,all P<0.05). 6. After reperfusion for 24 h, serum creatinine(Cr), blood urea nitrogen(BUN), rat kidney injury molecule(Kim-1) and malondialdehyde(MDA) concentration have no statistically significant differences between AOP group and PP group.(61.0±4.08 vs 63.8±7.47,11.62±1.27 vs 11.91±3.31,19590.53±3556.99 vs 18498.22±2949.62,270.91±36.07 vs 270.78±27.95,all P>0.05).ConclusionAfter reperfusion for 24 h, serious kidney damage occurrs in ischemia reperfusion group(I/R group), 15 mm Hg pneumoperitoneum preconditioning group(PP group),and renal artery occlusion preconditioning group(AOP group). Both 15 mm Hg pneumoperitoneum preconditioning and renal artery occlusion preconditioning can effectively reduce the ischemia reperfusion damage, but this protective effect is limited, and not able to completely avoid the kidney damage of ischemia reperfusion. 15 mm Hg Pneumoperitoneum preconditioning group(group PP) and renal artery occlusion preconditioning group(AOP group) have no statistically significant difference in kidney damage caused by ischemia reperfusion. In laparoscopic nephron sparing operation, 15 mm Hg pneumoperitoneum preconditioning is an effective method to alleviate the kidney damage caused by ischemia reperfusion.