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694 URINE.
tissue, and the creatinine, according to Folin, is a product of the endo-
genous protein metabolism.
Reports as to the behavior of the creatinine elimination with work
are conflicting, v. Hoogenhuyze and Verploegh, who made use of
a much more trustworthy method of quantitative estimation than their
predecessors, find that muscular activity as a rule does not cause any
rise in the creatinine elimination, and that in man such a rise with work
occurs only when the body is obliged to live upon its own tissues. S.
Weber l
also finds an absolute increase in the elimination of creatinine
onty in starving dogs. Other investigators could not find any increase
in the elimination of creatinine by work, although such a rise was found
as shown by Pekelharing and Harkink,2
by the muscle tonus.
In starvation, a decrease in the creatinine but a simultaneous increase
in the elimination of creatine has been found in man (v. Hoogenhuyze
and Verploegh, Cathcart, Benedict and Myers 3
). Such an increase
in the creatinine elimination only occurs in those conditions which are
accompanied by acidosis, and correspondingly it can be prevented by
the introduction of carbohydrates (Cathcart, Mendel and Rose)
The creatinine elimination in certain cases has therefore been explained
by a disturbed carbohydrate metabolism. This is neverthless on the
other hand disputed by Wolf and Oesterberg 4
who find that the crea-
tinine elimination in starvation can be arrested by the introduction of
proteins alone.
Little is known about the behavior of creatinine in disease, nor are
the observations in accord. In anaemia and cachexia the elimination
of creatinine is diminished, and when the metabolism is increased the
elimination is also increased. That this is the case, at least in fevers,
seems to be borne out by several concurrent observations.5
In diseases
of the liver a diminished elimination of creatinine may occur, and in cases
of carcinoma of the liver considerable creatine has been found in the urine
(v. Hoogenhuyze and Verploegh, Mellanby). The role of the liver
in the creatine-creatinine metabolism, is, as has already been mentioned
in Chapter X, not clear. The exclusion of the liver from the metabolism
of a dog with Eck fistula had no result in the experiments of Towles
1
Arch. f. exp. Path. u. Pharm., 58. Further literature may be found in v. Hoog-
enhuyze and Verploegh, Zeitschr. f. physiol. Chem., 46.
2
Maillard and Clausmann, Journ. de Physiol, et de Path., 12; Prayon, Maly’s
Jahresb., 40; Pekelharing and Harkink, Zeitschr. f. physiol. Chem., 75.
3
v. Hoogenhuyze and Verploegh, Zeitschr. f. physiol. Chem., 57; Cathcart, Bioch.
Zeitschr., 6; Benedict and Myers, Amer. Journ. of Physiol., 18; Jaffe, 1. c.
4
Cathcart, Jour, of Physiol., 39: Mendel and Rose, Journ. of biol. Chem., 10;
Wolf and Osterberg, Bioch. Zeitschr., 35; Wolf, Journ. of biol. Chem., 10.
6
See 0. af Klercker, Zeitschr. f. klin. Med., 68.
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