John Traylor, an unemployed black youth aged 23, was referred with a history of kidney disease starting at age 14, with the appearance of protein in the urine on a routine exam. A kidney biopsy showed glomerulonephritis. By age 18, serum creatinine began to rise, reaching 4.0 mg per dl.
Except for intermittent gout and high blood pressure, he had had no symptoms. Physical exam showed only obesity. (By this time blood pressure was controlled with drugs.) Blood potassium level was alarmingly high until an ACE inhibitor was discontinued. Blood pressure was hard to control. Allopurinol was prescribed for gout, but repeated episodes occurred despite the drug. A very-low-protein diet plus essential amino acids was prescribed at age 24. Kidney function continued to decline. Ketoconazole plus low-dose prednisone was added at age 27. Progression slowed. This regimen was continued for three more years, until he finally went on dialysis at age 30.
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