In a retrospective study, we identified 55 elderly patients with acute renal failure (ARF) admitted to our hospital during an 8-year period from 1985 to 1993. Information about the etiology, complications, laboratory data, and treatment course were obtained from the clinical history. Of the 200 patients with ARF admitted to the hospital during this period, 28% were patients more than 60 years old (41 male and 14 female) with an average age of 68.5 +/- 7 years. The main causes of ARF were sepsis, volume depletion, low cardiac output, arterial hypotension, nephrotoxicity by antibiotics, and obstructive uropathy. The global mortality of elderly patients with ARF was 53%. The mortality rate of the different types of the ARF were: prerenal 35%, intrinsic 64% (oliguric 76%, nonoliguric 50%), and postrenal 40%. Mortality as a result of sepsis occurred in 18 patients (62%), by cardiovascular disease in 4 patients (13%), by acute respiratory failure in 2 patients (7%), and by other causes in 5 patients (18%). In the cases of sepsis, Pseudomonas was detected in 7 cases (39%), Escherichia coli in 2 cases (11%), Gram-negative nonspecific in 3 cases (17%), Klebsiella in 1 case (5%), and in 5 cases (16%), the hemoculture was negative. The patient survival rate was 47% (26 of 55 patients). Of these patients, 19 recovered their normal renal function (73%), but 7 patients remained with renal failure (27%). In conclusion, the global mortality in the elderly patients without considering the types of ARF was 53%. The oliguric form had the highest mortality rate with 76%. The main causes for mortality were sepsis with 62%, cardiovascular disease with 13%, and other causes 18%.

Paraguay is a landlocked country located in South America with a total population of 5,884,491. Most of the population (95%) is mestizo, a mixture of Spanish and American/Indian races. The total number of indigenous people in the country has increased from 38,703 in 1981 to 85,674 in 2002. The gross domestic product per capita was US $932.00 annually per person in the year 2002. Between 1992 and 1997, there were 380 patients on chronic dialysis in Paraguay and 75 patients received renal transplants, mostly living-related. The prevalence of renal replacement therapy was 87 patients per million, and the incidence of renal disease continues to rise. Seventy percent of cases of ESRD are of unknown etiology and 15% have diabetes-related renal disease. Only citizens covered by the employee's national health insurance have complete coverage for dialysis and transplantation. The remainder of the population has to apply to public hospitals when the need for hemodialysis arises. At such hospitals, they can receive hemodialysis coverage from the National Institute of Nephrology or from other medical foundations to obtain entrance to these programs. They must otherwise use their own resources to pay for treatment. Seventy percent of patients on chronic dialysis turn to public hospitals for treatment. Hospital hemodialysis is the method most widely used. Home dialysis is rarely performed and there are very few programs for ambulatory peritoneal dialysis. Thus, a large number of patients are not able to enter chronic dialysis programs. In a recent survey of 4655 ill children registered, the distribution of main renal disease was acute glomerulonephritis in 42 cases (9 per 1000), nephrotic syndrome in 40 cases (8.5 per 1000), systemic lupus erythematosis in 28 cases (6 per 1000), and hematuria alone in 11 cases (2.3 per 1000). In ambulatory pediatric practice, urinary tract infection is the leading reason for seeking medical advice. Two thirds of such cases are associated with urinary tract anomalies. Children with ESRD are able to enter hemodialysis programs, but there are not sufficient resources to transplant them. Over 60% of the children with ESRD are hospitalized with terminal renal failure; malformations of the urinary tract are the usual cause. One study of 9880 adults aged 18 to 74 years reported that 39.1% of the women and 26.8% of the men examined were found to have hypertension. Almost half who were found to have raised blood pressure in this study were not previously known to have hypertension. In another cross-sectional study of the urban and suburban mestizo population of Asuncion among patients between 20 and 74 years of age, the overall prevalence of diabetes mellitus was 6.5%, impaired glucose tolerance 13.5%, hypertension 17%, and obesity 31.6%. Extrapolating from this data, we can assume that 178,000 patients with hypertension in Paraguay need medical treatment. To face the problem of growing numbers of patients with end-stage renal failure, it is necessary to carry out basic epidemiologic research to detect...

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Introduction and Objectives: NODAT is a well-recognized complication of solid organ transplantation. Its prevalence in Paraguay is unknown. The objective of this study was to determine the prevalence of NODAT in a kidney transplant population of Paraguay and to identify contributing risk factors. Materials and Methods: Retrospective, descriptive, observational study with an analytical component. From February 2010 to January 2020, 77 first kidney transplants were performed at our institution. The patients included were ≥18 years old, 10 patients were excluded for being DM2. The variables studied were: sex, age, BMI, abdominal circumference, family history of DM2, etiology of CKD, type of donor and immunosuppression used, lipid profile, renal function, and proteinuria at discharge and one year after transplant. Results: Of the 67 recipients, 49/67 (73.1%) were male, age 45.1 ± 11.6 years; in 36/67 (53.7%) the etiology was unknown, family history of DM2 present in 4/67 (5.9%). The donors were cadaveric in 54/67 (80.5%), tacrolimus (Tac) was the preferred calcineurin in 62/67 (92.5%). Glycemia at 12 months had a significant increase with p= 0.0007. Overweight and type I and II obesity were present in 38.8% and 22.3%, respectively, one year after the transplant and presented a statistically significant difference with the BMI at discharge with a p= 0.0041. The other variables did not present significant differences in the two cuts made. NODAT developed in 10/67 (14.9%) patients; in this population, 89.5% were male, mean age 53.6 years, 85.7% received cadaveric donation, all received CT scan and none had hypomagnesemia. Overweight and type I and II obesity were present in 50% and 30%, respectively. LDL cholesterol was 147.1 ± 26.2 mg/dL, median renal function was 62 mL/min/1.73 m2, and median proteinuria was 180 mg/day. Conclusion: The prevalence of NODAT was 14.9% in 10 years. Those who developed it were men, with a mean age of 53.1 years, with a transplant from a cadaveric donor and Tac was the most used drug. Most had body mass index of overweight/obesity and hyperlipidemia. There was no correlation with hypomagnesemia. The renal function of the graft was not affected at one year of follow-up in these patients.