Epidemic of Chronic Kidney Disease of Nontraditional Etiology in El Salvador: Integrated Health Sector Action and South-South Cooperation.

In El Salvador, chronic kidney disease had reached epidemic propor-tions towards the end of this century's first decade. In 2011-2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fa-talities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity.In 2009, El Salvador's Ministry of Health, Cuba's Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%-14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4-2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hyperten-sion, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional altera-tions and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon refiexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physio-pathologic, clinical and histopathologic characterization of chronic kid-ney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which par-ticularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. KEYWORDS Chronic kidney disease; chronic renal failure; tubuloint-erstitial nephritis; epidemiology; histopathology; international coopera-tion; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba.

Bacteriuria asintomática en embarazadas / Asymptomatic bacteriuria in pregnant women

Se hizo un pesquisaje de bacteriuria asintomática en 462 embarazadas, en un período de tres meses, residentes en un área urbana, que asistieron a la primera consulta prenatal en los cinco policlínicos de la ciudad de Holguín. La recolección de la muestra de orina de "chorro medio" y usando el método semicuantitativo de lámino-cultivo URIDIP, se hizo en la propia consulta por la enfermera obstetra. Se consideró que la embarazada tenía una bacteriuria asintomática, cuando en tres cultivos de orina sucesivos se obtuvo un crecimiento bacteriano de 100 000 colonias o más, en ausencia de síntomas urinarios en el momento de estudio. La frecuencia de bacteriuria asintomática encontrada fue el 2,8 por ciento y se incremento significativamente en las multíparas, de tres o más partos hasta el 8,7 por ciento. Además, parece existir una tendencia a incrementarse aún más la frecuencia en las embarazadas multíparas de mayor edad. Se destaca la importancia de la búsqueda de la bacteriuria asintomática desde el primer trimestre del embarazo (AU)