Review for 10.1186/1471-230X-7-1 (2007)

Reviewer's report 
 Urodilatin Increases Natriuresis in Cirrhosis Patients with Sodium Retention. Title: 
 1  10 September 2006 Version: Date: 
 giorgio della rocca Reviewer: 
Reviewer's report: 
General 
This interesting paper deals with the synthetic urodilatin activity and the renal potency (diuretic and 
natriuretic effects ) in cirrhotic patients. There are some methodological problems that make the paper difficult to be appreciated. Is the number of pts studied correct? Do you need to study a larger number of pts? 
METHODS. 
Patients. Page 4. 1st paragraph. In the inclusion criteria you have to include the child score of all the patients to realize the real cirrhotic status. 
2nd paragraph. You enrolled 7 pts (that are a very limited number) and you perform more than one test per 
patient. You have to report the precise number of test you did and in how many pts. This uis a crucial point of the paper as from fig. 1 we can see only 12 triangles and lines it means you performed 12 test (six per group) in 7 pts. What about the power of the study? 
2nd paragraph. You enrolled 3 pts with liver biopsy, 4 pts with esophageal varices. Are they at the same 
cirrhotic status? You need to report their child-pugh score. 
Furosemide range between 40 and 120 mg per day is a very quite large range to study on pts the renal potency of a drug. Please report the precise dose for all the pts in a table to verify that the groups were 
really similar. 
3rd paragraph. Plasma creatinine was 67… in all the pts? Please report the precise level for all the pts in a table to verify that the groups were really similar. Design. 
Page 5. You have to report how many times did you study the 7 patients and how many times the same 
patients (and which patients). In other words you have to create a new table in which you report all the data you collected patients per patints. Procedures. 
Page 5. You discontinued the diuretics the day before, but we do not know how much the urine flow 
decreased…. Please report the urine output before the procedures. Statistical analysis. You need to calculate the power to give the right support at the study. 
RESULTS 
Urine sodium excretion rate. Page 7. There is a baseline difference that has to be justified and discussed (19 vs 29). Particularly with respect to which patients (child score, diuretics dose etc…). The Delta you used to evaluate the 
performance it is not enough. You cannot rite that placebo had no appreciate difference as Na excretion 
increased also in that case. Second messenger GMP. Page 7. “this response was not related to the natriuretic response”. Please show it. 
Renine ang II and aldosterone. 
Page 7. “They were not inversely related to the natriuretic response to URO” . Please show it. Page 8 . Systemic BP and PR: please change with the international conventional terms AP and HR. DISCUSSION. 
Page 10. 3rd paragraph. “we stopped the diuretics first”: Was the dose of diuretics similar in both groups? 
Were there any difference between furosemide and spironolactone? Which serum creatinine level had the 2 
groups? 
Page 11. 2nd paragraph. The conclusion must be supported by all the details that are missing, included the 
grade of “decompensated cirrhotic pts” 
Include all tables necessary to undrestand all the patients. 
The references are very "old" ranging from to 1998. PLease use more recent references. 
------------------------------------------------------------------------------- 
------------------------------------------------------------------------------- 
Minor Essential Revisions. 
Tables and figures are missing to expalin all the data of the paper. 
------------------------------------------------------------------------------- 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: