Norton Cox, a 77-year-old retired NASA engineer, was referred in April 2000 with a five-year history of high blood pressure and chronic kidney failure. He also had an enlarged prostate. Despite treatment with an ACE inhibitor, serum creatinine concentration had increased to 3.3 mg per dl. He had had one episode of amnesia three years ago, which left him with some problems with memory ever since. He complained of muscle cramps, but only after playing tennis. He had no other symptoms. He was placed on a very-low-protein diet supplemented by essential amino acids. In the ensuing two years, his kidney function (measured every three months) has not changed. He remains essentially free of symptoms. He may never go on dialysis.
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