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Aim: The novel coronavirus disease 2019 (COVID-19) was first described in Wuhan, China, in December 2019. It has since spread worldwide, leading to high morbidity and mortality. Patients with chronic renal failure on dialysis who also have a confirmed diagnosis of active infection represent a risk group because infections are the second cause of death in this group, followed by immunosuppression caused by the weakening of the innate immunity by uremic toxins. This study aimed to describe the clinical characteristics of patients undergoing haemodialysis who also have a confirmed diagnosis for COVID-19 and its association with short-term outcomes.

Purpose: 1) To determine the prevalence of Urinary Incontinence, and it's impacts on quality of life in an elderly ambulatory cohort, affiliated to a large academic hospital in Argentina. 2) To test the feasibility of a telephone survey in this age group in our country. Method: A structured telephone survey was administered to 400 elderly people randomly selected from Hospital Italiano de Buenos Aires database. Participans were elegible if they were over 65 years old, with at least one year of assistance in our Institution, and were capable of answering without help. Results: 236 subjects were contacted (54% response rate). The prevalence found was 9% in the last month.is a high prevalence of urinary incountinence symptoms in elderly people in this Argentinean sample, similar to that published in other settings. We conclude that this kind of survey we applicate to the population is a good way of performed questions to elderly people, and the rate of response was satisfactory.

Chyloperitoneum is a rare complication in peritoneal dialysis. This entity is defined by the presence of high concentration triglycerides in the peritoneal effusion. In this paper two cases of chyloperitoneum secondary to lecardipine are described; and their causes, characteristics, and differential diagnoses are discussed

Designer drugs or synthetic drugs are manufactured from modifying the chemical structure of certain natural products or drugs, with psychotropic effect. The clinical picture is characterized by producing altered mental status associated with mydriasis, tachycardia, hypertension, nausea, chills, sweating, tremor and hyperthermia. Given the importance that the acute renal failure has among complications induced by these drugs, they are detailed in this paper: fall in renal blood flow, acute parenchymal damage, urinary obstruction, and mixed mechanism. For this reason, the renal treatment to be implemented depends on the correct assessment and understanding of the mechanisms involved in the renal patient alteration.

The main physiological test currently used for evaluating renal dilution capability is the hypotonic infusion test (HIT), which also evaluates proximal and thick ascending limb of Henle´s loops (TALH) function. There is another urine dilution test: oral water load test, and it is simpler than HIT. However, it has not been documented yet if oral water load test performs an adequate evaluation of proximal tubule and TAHL activity, as HIT does. Thus, we decided to evaluate if there was any significant difference between both tests by evaluating: maximum urinary dilution capability, proximal sodium clearance, and TAHL sodium reabsorption. Materials and Method: Both urine dilution evaluating tests were prospectively performed to forty healthy volunteers with the aim of measuring the following physiological parameters by them: maximum urine hypotonicity, free water clearance, proximal tubule sodium clearance, and TALH sodium reabsorption. Results: All volunteers were able to maximally dilute their urine during HIT, while only 4 volunteers (10%) were not able to do it during the oral water load tests. No significant difference was documented in the three studied parameters between both tests, in those patients who were able to maximally dilute their urine (n: 36) (p= NS). In conclusion this study has documented that HIT and oral water load test showed to be adequate studies for evaluating urine dilution capability, proximal and TAHL function. However, while HIT was more effective in obtaining the maximal dilution status, the oral water load test showed to be a simpler study.

Objectives: This work is a comparative analysis of health capital, frailty and ageing among old people with and without means of support. Material and Methods: Target population are individuals older than 50 years old, Intervention Group have lower socio-economic status and live in slums. Control Group belong to a higher social clas living in an urban population with all the material resources. Results: The data analyzed corresponds to a sample of 448 people. Comparison between both groups was not rendered as significant. Conclusions: In Our observation, populations exposed to hostile environments evidence for decades to be functionally apt to defend themselves from it.

The concepts of renal perfusion pressure (RPP) and renal blood flow (RBF) are usually confused, but although they are intimately related, they are not strictly the same. RPP originates from the minute cardiac volume and is, therefore, the cause of RBF, which generates glomerular filtration and as a consequence, also induces the urinary flow. On the other hand, whereas RPP can be subject to fluctuations, the same happens to RBF though at a much lower level due to the existence of physiological mechanisms, such as self-regulation of the flow and tubule-glomerular feed-back. We conclude that there is a dependence of the RBF in relation with RPP, with the former acting as the final responsible of the glomerular filtration.

Peritoneal dialysis is a renal replacement therapy, conducted through the peritoneal membrane, which facilitates the exchange of substances between two compartments: blood and peritoneal cavity. There are drug characteristics (smallness, lipid solubility, etc.) that favor its spread, some of the peritoneum (thin thickness, etc.) and others of the dialysate (osmolarity, etc).

Renal physiology plays a key role in the pharmacokinetics of many drugs. Knowledge of the particularities of each nephron function (filtration, secretion, reabsorption and excretion) and each of renal tubular transport mechanisms (simple diffusion, facilitated diffusion, facilitated transport, active transport, endocytosis and pinocytosis) is fundamental to achieve better management of drug prescriptions.

The prevalence of nutritional disorders and polypharmacy in the elderly is very high. We evaluated the occurrence of both in patients older than 80 years who were admitted in an acute patients ' hospital. 72.5% of patients who took more than 5 drugs were malnourished on admission. Even though more research is needed in this field, it seems that polypharmacy is associated to malnourishment in very old people.

It is widely described in the literature that rhabdomyolysis can potentially cause acute renal failure, and that repeated episodes of hemoglobinuria-hematuria (paroxysmal hemoglobinuria and IgA glomerulopathy) can generate progressive renal damage and consequently chronic renal disease. In this report we describe a chronic renal failure that due to its clinical context and way of installation, it strongly suggests the possibilityof the existence of a mechanism of chronic renal damage (causal or concausal) secondary to repeated episodes of rhabdomyolysis.

Objectives: This study aimed to investigate the knowledge and attitudes of Argentine women 65 years of age and older regarding urinary incontinence (UI). Methods: A cross-sectional study of 238 community-dwelling Argentine women 65 years of age and older was conducted in San Justo, Argentina. Data were collected by in-person interviews. Results: Regarding knowledge, 232 (97.5%) of the women surveyed were familiar with the term urinary incontinence, but 152 (63.9%) falsely believed that UI is a normal part of aging and 163 (68.5%) did not know about pelvic exercises or a surgical option to treat UI. A total of 106 (44.5%) women reported symptoms of UI. Discussion: Older Argentine women are misinformed about UI. Interventions are necessary to increase their knowledge and healthcare seeking behaviors.

Background: Magnesium and phosphorus are one of the electrolytes whose balance is altered during advanced chronic renal failure (CRD-V). It has already been reported in the literature that there is a progressive increase in urinary electrolyte excretion in CRD-V in relation with the glomerular filtration rate reduction, but it has not been extensively studied yet for these divalent ions. Therefore we decided to perform a study for evaluating compared values of urinary and peritoneal fractional excretion of these divalent ions (magnesium and phosphorus) among patients on peritoneal dialysis with residual diuresis (CRD-V), stage III - chronic renal failure, and healthy volunteers. Results: Urinary fractional excretion (FEu) of magnesium (Mg) and phosphorus (P) were significantly (p= < 0.05) lower in healthy volunteers (FEuMg: 3 ± 1%, FEuP: 9 ± 0.5%), and significantly higher in CRD-V (FEuMg: 30 ± 4%, FEuP: 40 ± 0.2%). Regarding peritoneal fractional excretion (FEp) of magnesium and phosphorus, they were significantly higher (p= < 0.05) (FEpMg: 36 ± 5%, FEpP: 62 ± 9%) than the urinary ones in the same population: CRD-V. Conclusion: Magnesium and phosphorus urinary fractional excretion values were significantly higher in the CRD-V group, while these values were significantly lower than the peritoneal ones in the same population: CRD-V.

Background: Magnesium and phosphorus are one of the electrolytes whose balance is altered during advanced chronic renal failure (CRD-V). It has already been reported in the literature that there is a progressive increase in urinary electrolyte excretion in CRD-V in relation with the glomerular filtration rate reduction, but it has not been extensively studied yet for these divalent ions. Therefore we decided to perform a study for evaluating compared values of urinary and peritoneal fractional excretion of these divalent ions (magnesium and phosphorus) among patients on peritoneal dialysis with residual diuresis (CRD-V), stage III - chronic renal failure, and healthy volunteers. Results: Urinary fractional excretion (FEu) of magnesium (Mg) and phosphorus (P) were significantly (p= < 0.05) lower in healthy volunteers (FEuMg: 3 ± 1%, FEuP: 9 ± 0.5%), and significantly higher in CRD-V (FEuMg: 30 ± 4%, FEuP: 40 ± 0.2%). Regarding peritoneal fractional excretion (FEp) of magnesium and phosphorus, they were significantly higher (p= < 0.05) (FEpMg: 36 ± 5%, FEpP: 62 ± 9%) than the urinary ones in the same population: CRD-V. Conclusion: Magnesium and phosphorus urinary fractional excretion values were significantly higher in the CRD-V group, while these values were significantly lower than the peritoneal ones in the same population: CRD-V.

El granuloma de sitio de salida es una de las complicaciones más frecuentes asociadas al catéter de diálisis peritoneal, la cual suele resolverse mediante tratamiento médico, sin embargo a veces sólo resuelve con tratamiento quirúrgico. En el siguiente reporte presentamos un caso clínico que constituye un ejemplo de ello.

Exit site granuloma is one of the most frequent complications associated to peritoneal dialysis catheter, which usually solves by medical treatment, but sometimes it only solves by surgery. In the following reports we present a clinical case which represents an example of this.

Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urinary tract occlusion at any part of it. The inducing urinary obstruction diseases can vary depending on the patient´s age and gender.There are many renal dysfunction inducing mechanisms involved in this entity: increase in the intra-luminal pressure, ureteral dilatation with ineffective ureteral peristalsis, glomerular ultrafiltration net pressure reduction, intra-renal glomerular blood flux reduction due to vasoconstriction, and local disease of chemotactic substances. Obstructive nephropathy can also lead to hypertension (vasoconstriction-hypervolemia), hyperkalemia, metabolic acidosis (aldosterone resistance), diabetes insipidus (vasopressine resistance).In conclusion, since obstructive nephropathy is a potentially reversible cause of renal dysfunction, it should always be taken into account among the differential diagnosis of renal failure inducing mechanisms.

Carbamazepine and oxcarbazepine are antiepileptic drugs which can induce hyponatremia, being this disorder more frequent with the latter.In this report we present a clinical case regarding an oxcarbazepine induced hyponatremia, and we hypothesized that oxcarbazepine could induce hyponatremia as a consequence of its influence on distal nephron where it could promote free water retention, urinary sodium loss, or both of them.Besides, we proposed that a greater tubular sesitivity to oxcarbazepine than to carbamazepine could explain the different hyponatremia inducing capability between these two drugs

La fibrosis sistémica nefrogénica (FSN) es una entidad infrecuente, que se desarrolla en pacientes insuficientes renales en diálisis, vinculándose su etiopatogenia con diversos factores tales como el uso de gadolinio intravenoso, el antecedente de cirugías vasculares, etc.El Tamoxifeno, es un modulador selectivo (inhibición competitiva) de los receptores estrogénicos, que posee propiedades antifibróticas las cuales se emplean para el tratamiento de entidades tales como: fibrosis retroperitoneal, esclerosis peritoneal asociada a diálisis peritoneal, tumores desmoides y en algunos casos de esclerodermia.En el presente articulo presentamos la hipótesis original de que el tamoxifeno, por su propiedades fibrinolíticas, podría ser una terapia no inmunosupresora potencialmente útil para el tratamiento de la fibrosis sistémica nefrogénica, evitándose desde ya su uso en pacientes portadores de contraindicaciones para recibirlo.

Nephrogenic systemic fibrosis is (NSF) a rare entity which develops in patients with renal failure undergoing dialysis, and its etiology is related to several factors such as the use of intravenous gadolinium, vascular surgeries, etc.Tamoxifen, is a selective modulator (competitive inhibition) of estrogen receptors, and it has antifibrotic properties which are used for treating retroperitoneal fibrosis, peritoneal sclerosis associated to peritoneal dialysis, desmoids tumors and in some cases of sclerodermia.In the present article, it is presented the hypothesis of a potential use of tamoxifen as a non immunosuppressant treatment for NSF in patients who have no contraindication for receiving it.

La carbamazepina y la oxcarbazepina son drogas antiepilépticas potencialmente inductoras de hiponatremia, siendo este disturbio más frecuente con ésta última.En este reporte presentamos un caso de hiponatremia inducida por oxcarbazepina, y proponemos una potencial explicación fisiopatológica para esta entidad, a la cual se la considera consecuencia de un aumento a nivel de los túmulos colectores de la reabsorción de agua libre, de la pérdida urinaria de sodio, o de ambos fenómenos combinados.Además, postulamos que la mayor propensión a la aparición de hiponatremia con el uso de oxcarbazepina respecto del empleo de carbamazepina podría ser consecuencia de una mayor sensibilidad de los túmulos colectores a la primera de las drogas mencionadas.

La enfermedad de Gaucher es un trastorno genético autosómico recesivo generador de un déficit de la enzima lisosomal glucosilceramida-beta-glucosidasa ácida. Dicha enzima degrada la glucosilceramida, sustancia a partir de la cual se sintetizan muchos esfingo y glucolípidos. La falta de su degradación conduce a su almacenamiento en los macrófagos tisulares con las consiguientes complicaciones mecánicas y funcionales. El compromiso renal es infrecuente en esta enfermedad, pero cuando se presenta lo hace bajo la forma de proteinuria aislada o glomerulonefritis.El sindrome de Fanconi consiste en la disfunción parcial o total de los túbulos proximales renales. Existen diversas entidades que pueden inducir este síndrome, pero no hay hasta ahora informes en la literatura que lo vinculen con la enfermedad de Gaucher.Presentamos un caso clínico en el cual se logró documentar dicha asociación.

Gaucher´s disease consists of a genetic autosomic recesive alteration that leads to a reduction in the acid glucosil-ceramide beta-glucosidase enzyme. This enzyme brakes the glucosilceramide, a substance from which many esphingo and glucolipids are synthesized. Even though the renal compromise is not frequent in Gaucher disease, proteinuria (in nephrotic range or not) and glomerulonephritis have been described in this illness.Fanconi syndrome is charaterized by a dysfunction in the proximal tubular reabsorption. Among the etiologies of Fanconi syndrome there are many metabolic diseases, but no association has been described yet in the literature between Fanconi syndrome and Gaucher disease. We present the following case report where this association was observed.

SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels. RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.

RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal. SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.

Hypothyroidism can cause disturbance of renal hemodinamics, kidney histology, water and electrolyte metabolism, being hyponatremia and glomerular filtration reduction their low prevalent but most significant consequences. All these changes are largely corrected by substitution of exogenous thyroid hormone.Fractional excretion of urea (FEU) is a useful index in the evaluation of hyponatremia. However, it was not still reported in the literature the FEU value in hyponatremia induced by hypothyroidism. Because of that we presented a case report showing that the value of FEU and fractional excretion of sodium (FENa) were low (FEU: 29%) and high (FENa: 2.2 %) respectively in a severe hypothyroid patient. Treatment based on thyroid hormone normalized both indeces.RESUMEN:El hipotiroidismo puede causar alteraciones del metabolismo del agua, los electrolitos, la hemodinamia e histología renales, siendo la hiponatremia y la reducción del filtrado glomerular sus consecuencias más significativas, pero poco prevalentes. Todos estos cambios son corregibles con el suministro de hormona tiroidea exógena.La excreción fraccional de urea (EFU) es un índice útil en la evaluación de la hiponatremia, pero no se ha descripto aun el valor que este índice alcanza en la hiponatremia inducida por hipotiroidismo. En el presente reporte mostramos que la EFU y excreción fraccional de sodio (EFNa) fueron baja (EFU: 29%) y alta (EFNa: 2.2%) respectivamente en un paciente que padecía hipotiroidismo severo. El tratamiento con hormona tiroidea normalizó el valor de ambos índices.

RESUMEN:La insuficiencia renal aguda (IRA) es un trastorno frecuente en los ancianos a raíz de la senescencia renal, la menor metabolización de los fármacos y la mayor exposición a la polifarmacia y enfermedades sistémicas que ellos padecen. Las siguientes son las principales características de la IRA en el anciano: carácter multifactorial, presentación clínica atípica, fragilidad tubular, patrón de síndrome intermedio y poca fiabilidad del examen físico y de los índices urinarios en la interpretación de su etiología. Las medidas de profilaxis y rehidratación siguen siendo los mejores tratamientos de la IRA en el viejo. La biopsia renal y la diálisis tienen el mismo rol tanto en el grupo senil como en el joven.ABSTRACTACUTE RENAL FAILURE IN THE ELDERLY: PEARLS FOR ITS ASSESSMENT AND TREATMENT.Acute renal failure (ARF) is a frequent disorder in the elderly, and this phenomenon is due to the senescence process, reduced metabolization of drugs, increased exposure to polypharmacy and systemic diseases of the aged group. The following are the main characteristics of the ARF in the elderly: mulfactorial, atypical presentation, tubular frailty, intermediate syndrome pattern, low reliable physical examination and urinary indeces. Profilaxis and rehydration are the best treatments for ARF in the old population. Renal biopsy and dialysis have the same role in young and old people.

Fractional excretion of urea (FEurea) is a useful marker to evaluate renal perfusion in people with normal renal function. The value of this marker in a well hydrated person is around 50%, in a low renal perfusion state is lower than 35%, and in an over-hydrated state is higher than 65%.A recent study reported that well-hydrated healthy old and very old people had FEurea higher than young people under the same conditions. That faced us with the fact that there is no information about FEurea values during abnormal renal perfusion states in the elderly.We present two dehydrated elderly patients with dementia that provided us with an opportunity to evaluate the FEurea.Conclusion: We observed that only during severe dehydration an old patient with dementia reached a low FEurea (20%) as a young person. When these patients were dehydrated (hypernatremic) but not hypotensive they showed FEurea higher than a young patient. It seems that new FEurea values are needed in this age group to interpret altered renal perfusion states.

La excreción fraccional de urea (EFurea) es un marcador útil en la evaluación del estado de perfusión renal en personas con riñón normofuncionante. El valor de este marcador en un paciente bien hidratado es de alrededor del 50%, en una persona con hipoperfusión renal es menor del 35% y en una persona sobrehidratada es mayor del 65%. Estos valores de referencia provienen de estudios en personas jóvenes.Un estudio reciente demostró que en personas ancianas (edad entre 65-79 años) y muy ancianas (edad mayor a 79 años) sanas y en buen estado de hidratación, la EFurea fue mayor que la observada en jóvenes sanos normohidratados. Esto nos hizo notar que no existen hasta la fecha valores normales conocidos de EFurea en pacientes gerontes cursando estados de alteración de la perfusión renal.Presentamos los siguientes casos clínicos por ser una buena oportunidad para apreciar el valor de EFurea alcanzado por personas ancianas dementizadas bajo un estado de severa hipoperfusión renal, a raíz de un cuadro de deshidratación con severa hipernatremia.Conclusión: De los dos casos analizados sólo uno presentó en sus inicios además de severa deshidratación hipotensión arterial, y fue sólo en ese contexto que logró una EFurea baja (EFurea 20%) como la que hubiera logrado una persona joven. Fuera del estado de hipotensión y aun con signos de deshidratación (hipernatremia) ambos pacientes ancianos y dementizados mostraron valores de EFurea más elevados que los que hubiera logrado un paciente joven. Pareciera que nuevos valores de referencia de EFurea son necesarios para la interpretación de los estados de alteración de la perfusión renal en esta población.

RESUMEN:El hipotiroidismo puede causar alteraciones del metabolismo del agua, los electrolitos, la hemodinamia e histología renales, siendo la hiponatremia y la reducción del filtrado glomerular sus consecuencias más significativas, pero poco prevalentes. Todos estos cambios son corregibles con el suministro de hormona tiroidea exógena.La excreción fraccional de urea (EFU) es un índice útil en la evaluación de la hiponatremia, pero no se ha descripto aun el valor que este índice alcanza en la hiponatremia inducida por hipotiroidismo. En el presente reporte mostramos que la EFU y excreción fraccional de sodio (EFNa) fueron baja (EFU: 29%) y alta (EFNa: 2.2%) respectivamente en un paciente que padecía hipotiroideo severo. El tratamiento con hormona tiroidea normalizó el valor de ambos índices.ABSTRACTHypothyroidism can cause disturbance of renal hemodinamics, kidney histology, water and electrolyte metabolism, being hyponatremia and glomerular filtration reduction their low prevalent but most significant consequences. All these changes are largely corrected by substitution of exogenous thyroid hormone.Fractional excretion of urea (FEU) is a useful index in the evaluation of hyponatremia. However, it was not still reported in the literature the FEU value in hyponatremia induced by hypothyroidism. Because of that we presented a case report showing that the value of FEU and fractional excretion of sodium (FENa) were low (FEU: 29%) and high (FENa: 2.2 %) respectively in a severe hypothyroid patient. Treatment based on thyroid hormone normalized both indeces.