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In Reply—We are appreciative of Matz' comments on our study concerning abnormally low serum creatinine levels and increased creatinine clearance values in severe hepatic disease. He observed similar kinds of constellations of low serum levels of creatinine and uric acid, low serum urea nitrogen levels, and increased creatinine clearance values in patients with alcoholic liver disease, although the levels of creatinine were in the low range of normal. However, the background of the patients is somewhat different. Their patients were almost invariably suffering from acute alcoholic hepatitis, and some of them recovered, in contrast to our patients with severe liver disease. He suggested a causative role of increased effective vascular volume without giving an explanation as to how the body fluid volume could increase in their alcoholic patients. He also had no data regarding the glomerular filtration rate measured by a reliable method.
TOSHIKAZU TAKABATAKE. Low Serum Creatinine Levels in Severe Hepatic Disease-Reply. Arch Intern Med. 1989;149(6):1471. doi:10.1001/archinte.1989.00390060173052