Epididymis microlithiasis and semen abnormalities in young adult kidney transplant recipients.

Microlithiasis of the epididymis is a rare ultrasound finding in the general population, but the incidence of calcifications in various organs of patients with end-stage renal disease (ESRD) is extremely high. The aim of this study was to describe epididymal microlithiasis in 22 previously dialysed patients who received kidney transplantations at a median age of 19 years (range 9-30). The patients underwent scrotum ultrasonography, semen analysis and laboratory tests (renal function, sexual hormones, Ca, P and PTH) and were administered the International Index of Erectile Function questionnaire. Seventeen presented calcifications of the epididymis, two of whom had concomitant testicular calcifications; a further three patients had isolated testicular calcifications without epididymis involvement. It was not possible to investigate the fertility of all of the patients but 12 of the 13 whose semen was analysed showed abnormalities: five were azoospermic and seven oligospermic with various degrees of morphological anomalies. To the best of our knowledge, these are the first published data concerning the prevalence of epididymal calcifications in young dialysed patients undergoing renal transplantation. Epididymal microlithiasis and infertility were common findings and so performing a spermiogram and preserving semen before ESRD for future paternity may be good advice in this selected population.

Assessment of nutritional status in children with chronic kidney disease.

The achievement of a normal nutritional status, that is a normal body composition and a normal pattern of growth, is a cornerstone in the management of children with chronic kidney disease (CKD). Protein-energy wasting (PEW) which indicates the state of decreased body protein mass and fuel reserves (body protein and fat mass), is a common condition in this population, and a source of morbidity and mortality. For the diagnosis of this condition, a lot of methods have been proposed, but due to the clinical characteristics of children with CKD, the intrinsic limits of the available indices and some methodological issues concerning published pediatric studies, none of these parameters could be considered as the gold standard. Given these limitations, a general consensus exists according to which only the combination of more indices integrated in a multidisciplinary approach can give the idea of the individual nutritional status. Among these indices, recent guidelines recommend dietary intake (by means of 3-day diary or 24-hour recall), anthropometric parameters (weight, height, height velocity, body mass index, head circumference) and, only for adolescent on hemodialysis, normalized protein catabolic rate as the most accurate ones. Other methods, such as mid-arm anthropometry, bioimpedance analysis, biochemical indices, and dual-energy X-ray absorptiometry could certainly help in the nutritional evaluation, taking into account the advantages and drawbacks of each method.