Reviewer's report 
 The Changes in Renal Function after a Single Dose of intravenous Furosemide in Patients with Title: 
Compensated Liver cirrhosis 
 3  25 September 2006 Version: Date: 
 Laurent Spahr Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
The authors have only partially responded to criticisms and comments. Several points have not been taken into consideration: international units are not given (micromole pr liter and not mg/dl); data are not given as median and range; individual values are not given in the figures; Results: there seems to be a tendency for 
an increase in DMSA in the furosemide 120 mg group as compared to the 40 mg group (5.6% vs 3.6%). 
This a probably a type II error due to the small size of the population. Were there any correlation between DMSA changes and 8h urinary sodium changes? Did the patients not increasing DMSA had a lower 
natriuretic response to furosemide? Why did the authors not confirm in this study the correlation at baseline 
between DMSA and GFR that they observed previously? 
Results: this section remains poorly organized. Some information regarding individual values in DMSA 
uptake are given in the abstract but not in the Results section!! Discussion and Conclusion: The increase in DMSA uptake following furosemide injection was observed in 
only 55% of the patients, which underlines that this test is probably less sensitive than UNa excretion at 8 
hours (but the proportion of the patients who increased UNa at 8 hrs is not given..). In addition, the DMSA 
response to 40 or 120 mg of furosemide does not allow to discriminate the response to diuretic, and thus the 
predictive value of this test (as compared to UNa at 8hrs) appears of limited value. 
In the Discussion section, the authors say: “ …clinical implication of this study shows…. that it identifies a 
subgroup of patients not responsive to diuretics..”. This assumption is not in accordance with the Results. Conclusion: The authors say: .. this may help in differentiating patients with lower treatment response…… but this is not supported by the data, showing that the 8hrs UNa was superior. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
English and spelling errors have not been revised (weak and not week, Henle and not Henley, …renin and 
not renine; ). ------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of insufficient interest to warrant publication in a scientific/medical journal Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Reviewer's report 
 The Changes in Renal Function after a Single Dose of intravenous Furosemide in Patients with Title: 
Compensated Liver cirrhosis 
 3  25 September 2006 Version: Date: 
 Laurent Spahr Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
The authors have only partially responded to criticisms and comments. Several points have not been taken into consideration: international units are not given (micromole pr liter and not mg/dl); data are not given as median and range; individual values are not given in the figures; Results: there seems to be a tendency for 
an increase in DMSA in the furosemide 120 mg group as compared to the 40 mg group (5.6% vs 3.6%). 
This a probably a type II error due to the small size of the population. Were there any correlation between DMSA changes and 8h urinary sodium changes? Did the patients not increasing DMSA had a lower 
natriuretic response to furosemide? Why did the authors not confirm in this study the correlation at baseline 
between DMSA and GFR that they observed previously? 
Results: this section remains poorly organized. Some information regarding individual values in DMSA 
uptake are given in the abstract but not in the Results section!! Discussion and Conclusion: The increase in DMSA uptake following furosemide injection was observed in 
only 55% of the patients, which underlines that this test is probably less sensitive than UNa excretion at 8 
hours (but the proportion of the patients who increased UNa at 8 hrs is not given..). In addition, the DMSA 
response to 40 or 120 mg of furosemide does not allow to discriminate the response to diuretic, and thus the 
predictive value of this test (as compared to UNa at 8hrs) appears of limited value. 
In the Discussion section, the authors say: “ …clinical implication of this study shows…. that it identifies a 
subgroup of patients not responsive to diuretics..”. This assumption is not in accordance with the Results. Conclusion: The authors say: .. this may help in differentiating patients with lower treatment response…… but this is not supported by the data, showing that the 8hrs UNa was superior. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
English and spelling errors have not been revised (weak and not week, Henle and not Henley, …renin and 
not renine; ). ------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of insufficient interest to warrant publication in a scientific/medical journal Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Please review this paper.
user
Reviewer's report 
 The Changes in Renal Function after a Single Dose of intravenous Furosemide in Patients with Title: 
Compensated Liver cirrhosis 
 3  25 September 2006 Version: Date: 
 Laurent Spahr Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
The authors have only partially responded to criticisms and comments. Several points have not been taken into consideration: international units are not given (micromole pr liter and not mg/dl); data are not given as median and range; individual values are not given in the figures; Results: there seems to be a tendency for 
an increase in DMSA in the furosemide 120 mg group as compared to the 40 mg group (5.6% vs 3.6%). 
This a probably a type II error due to the small size of the population. Were there any correlation between DMSA changes and 8h urinary sodium changes? Did the patients not increasing DMSA had a lower 
natriuretic response to furosemide? Why did the authors not confirm in this study the correlation at baseline 
between DMSA and GFR that they observed previously? 
Results: this section remains poorly organized. Some information regarding individual values in DMSA 
uptake are given in the abstract but not in the Results section!! Discussion and Conclusion: The increase in DMSA uptake following furosemide injection was observed in 
only 55% of the patients, which underlines that this test is probably less sensitive than UNa excretion at 8 
hours (but the proportion of the patients who increased UNa at 8 hrs is not given..). In addition, the DMSA 
response to 40 or 120 mg of furosemide does not allow to discriminate the response to diuretic, and thus the 
predictive value of this test (as compared to UNa at 8hrs) appears of limited value. 
In the Discussion section, the authors say: “ …clinical implication of this study shows…. that it identifies a 
subgroup of patients not responsive to diuretics..”. This assumption is not in accordance with the Results. Conclusion: The authors say: .. this may help in differentiating patients with lower treatment response…… but this is not supported by the data, showing that the 8hrs UNa was superior. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
English and spelling errors have not been revised (weak and not week, Henle and not Henley, …renin and 
not renine; ). ------------------------------------------------------------------------------- Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of insufficient interest to warrant publication in a scientific/medical journal Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
assistant