Abstract
At the May, 1914, meeting 1 attention was called to the accumulation of creatinine in the blood in advanced chronic interstitial nephritis, data being reported on two cases at that time. It was then suggested that the retention of creatinine might be of etiological importance in uremia on account of its containing the toxic guanidine group, and further that the creatinine might be of considerable prognostic value in advanced nephritis. Further study showed that as the permeability of the kidneys is lowered in conditions of renal insufficiency this becomes evident in the blood; first, by a retention of uric acid, later, by that of urea, and lastly by that of creatinine, indicating that creatinine is the most readily eliminated of these three nitrogenous waste products. 1 Theoretically, the amount of the increase of the creatinine in the blood should be a safer index of the decrease in the permeability of the kidneys than the urea, for the reason that creatinine on a meat free diet is entirely endogenous in origin and its formation (and elimination normally) very constant. Apparently the kidneys are never able to overcome the handicap of a high creatinine accumulation, for, we soon found that those cases in which the creatinine had risen above 5 mg. per 100 c.c. of blood rarely showed any marked improvement and almost invariably died within a comparatively limited time. 2 On the other hand, cases with high figures for urea, but without marked creatinine retention, generally showed improvement.
We have now had the opportunity of following 94 cases with creatinine values of 5 mg. or more. The outcome has been; died 83, unknown 3, unchanged 4, improved 2 and recovered 2. The two cases classified as recovered were acute cases in which the creatinine remained over 5 mg. for only a few days.
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