Fig. 7

The proposed mechanism of endothelial cell and kidney tubule injury that occurs in the standard and low pressure pneumoperitoneum. Normal baseline condition [A]. 1. Standard pressure (12 mmHg group) decreases interlobar artery blood flow and results in more changes from laminar flow to turbulent flow [B] than low pressure (8 mmHg group) [C]. 2. The inflammatory response in the 12 mmHg group produces higher IL-6 levels than the 8 mmHg group. 3. Interleukin-6 causes more syndecan-1 activation and shedding from the endothelial surface into the bloodstream in the 12 mmHg group than in the 8 mmHg group. 4. (a) Interleukin-6 and syndecan-1 stimulate VEGF-A synthesis and (b) binding to VEGFR-2 on the endothelial surface. 5. Activation of VEGFR-2 increases sVEGFR-2 levels more so in the 12 mmHg group than in the 8 mmHg group. 6. The expression of VEGFR-2 in tubular epithelial cells is higher in the 12 mmHg group, and the expression of syndecan-1 is lower in the 12 mmHg group than in the 8 mmHg group. 7. Due to inflammation, tubular epithelial cell injury stimulates the synthesis of KIM-1 molecules that will be released into the tubular lumen (urine). Figure courtesy of Dita Aditianingsih, MD, PhD. Permission to reuse the figure in any form must be obtained directly from Dr. Aditianingsih