Gross and microscopic findings at autopsy are reported in 66 patients with end-stage renal disease (ESRD). Nineteen patients received renal transplant, and 47 were maintained on chronic dialysis. Thyromegaly was seen in over half of the dialysis patients and in a third of the transplant recipients. The mean weight of the thyroid gland in the two groups was similar (26.2 ± 4.5 g in the transplant group and 27.2 ± 6 g in the group on dialysis). The parathyroid glands were hyperplastic in 10/11 dialysis patients (91%), but of normal size in 78% of the transplant recipients. Adrenal gland atrophy was common in the transplant group, probably reflecting adrenal suppression by glucocorticoids. Seminiferous tubular atrophy was observed in 12/16 dialysis patients and small testes were noted on gross examination in 50% of the transplant recipients. Prominent autopsy findings were goiter, parathyroid gland hyperplasia, and testicular atrophy. Following transplantation parathyroid gland hyperplasia declined, whereas goiter and testicular atrophy appeared to persist.
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