326 HERMAN O. MOSENTHAL 



Creatinin in Nephritis 



It was demonstrated almost simultaneously by Neubauer(e), Folin and 

 Denis, and Myers and Fine(fc) (1913), that an increase of blood creatinin 

 occurred in certain types of nephritis. According to Myers and Lough, 

 creatinin rises above 2.5 nig. per 100 c.c. of blood only in conditions as- 

 sociated with renal insufficiency; 2.5 to 3 mg. may be viewed with sus- 

 picion, 3.0 to 5 mg. indicate a decided retention of the nitrogenous waste 

 substances, while an amount above 5 mg. portends an early fatal termina- 

 tion. Myers and Kilian(fr) note that in exceptional instances such pa- 

 tients may live for one year. The author has seen several similar cases. 

 The above applies to chronic nephritis. In acute nephritis and bichlorid 

 of mercury poisoning such high levels of blood creatinin are not necessarily 

 significant of a fatal prognosis inasmuch as if the kidney again secretes 

 an adequate quantity of urine a complete recovery may ensue. In chronic 

 nephritis, the blood creatinin has been observed to be higher than 30 mg. 

 per 100 c.c. (Chace and Myers (6), 1916). In those cases of nephritis in 

 which no renal insufficiency exists the creatinin does not increase in the 

 blood. This applies particularly to certain cases of acute or chronic ne- 

 phritis with albuminuria in which the illness may be very severe and yet 

 no retention of creatinin or other nitrogenous waste products 'occurs unless 

 the oliguria becomes marked or anuria supervenes. 



Under normal conditions, the creatinin content of voluntary muscle 

 is two or three times as great as that of the blood. The subsequent table 

 (11) shows the normal values for the creatinin content of human voluntary 

 muscle to vary between 2 and 12 mg. per 100 gm. of tissue while the 

 blood creatinin usually varies between and 1 and 2 mg. and only in iso- 

 lated instances does it rise as high as 2.5 or 3 mg. In uremia the blood 

 creatinin accumulates faster than it does in the muscle (Myers and Fine 

 (d), 1915). There are comparatively few investigations concerning the 

 creatinin content of muscle in nephritis. 



It is evident that in nephritis there may be an increase in the muscular 

 creatinin which may assume considerable proportions. It is probable that 

 the creatinin in this tissue has no more significance than it has in the 

 blood, namely, retention because of renal insufficiency. The two cases of 

 acute nephritis cited in the table show no increase, whereas in the in- 

 stances of chronic nephritis the creatinin rises as high as 25 mg. per 100 

 gm. Presumably there are cases of acute nephritis in which the muscle 

 creatinin would be increased just as there are instances of acute nephritis 

 with a high blood creatinin, while in many it does not rise above the 

 normal level. The findings depend entirely upon the absence or presence 

 of renal insufficiency. 



All the facts thus far recorded agree with the view of a number of ob- 



