Jerry Strong, a 35-year-old social worker, had developed glomerulonephritis at age 19 and had had recurrent ankle swelling and occasional gout ever since. After one year of observation, he was started on a very-low-protein diet supplemented by either essential amino acids or ketoacids. By age 39 it was clear that his kidney disease was still progressing, and ketoconazole plus low-dose prednisone was added. For the next four years he continued this regimen. During this time he complained only of muscle cramps and mild fatigue. Injections of erythropoietin did not help his anemia. At age 43 he received a kidney transplant from his sister.
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