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The small intestinal bacterial flora of 15 patients with chronic renal insufficiency was compared with that of subjects with blind loop syndrome. 9 patients were on regular hemodialysis with high protein intake and 6 (serum creatinine 7.5 to 12.5 mg/dl) were maintained on low protein diet. The chronic renal patients harbored a greatly increased microbial flora of both anaerobes and aerobes in the duodenum and jejunum, quantitatively comparable to those in blind loop subjects. The composition did not differ significantly in the two groups. Some organisms may have the potential to metabolize substrates which reach the intestinal lumen from the diet and bile, and perhaps to generate toxic metabolites that could contribute to uremic toxicity or malabsorption.

have been proposed to explain the dilute urine excreted in water diuresis. Cushny (I) and Smith (2) may be consulted for references to the older literature. Theoretical concepts which have been current in recent years will be considered in more detail in the discussion at the end of this paper. The experiments reported here were devised to test the degree to which water diuresis is independent of large changes in urine flow and solute and water reabsorption in the nephron. In 15 experiments, water diuresis was combined with various grades of osmotic (urea) diuresis. In four experiments, water diuresis was combined with mercurial diuresis. In two experiments, water diuresis was superimposed on a combined osmotic and mercurial diuresis.

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