Patients with Diseases of the Glomeruli

Cary Moulin, a 40-year-old laboratory technician, was referred for treatment of glomerulonephritis, known to be progressive for the previous 19 years. He was an avid jogger, running about 48 miles a week. Physical exam showed only high blood pressure. His serum creatinine level was quite high (5.5 mg per dl), as was his serum urea nitrogen level (95 mg per dl; normal is less than 22 mg per dl); yet he had few symptoms. In response to a very low-protein diet supplemented by essential amino acids, serum urea nitrogen fell to 33 mg per dl. He also received antihypertensive drugs. He alternately took supplements of either essential amino acids or ketoacids for the next five years, at which point he finally went on dialysis. Subsequently he received a transplant.

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