Chester Land, a black retired postal supervisor, was referred at age 61 with a 20-year history of hypertension. By age 59 his serum creatinine level was elevated, though he had no symptoms of kidney disease. Physical exam showed only hypertension, but kidney function was severely reduced. He was prescribed a very-low-protein diet supplemented by essential amino acids or ketoacids (in addition to his antihypertensive drugs and diuretics). A few years later a routine lab report raised the spectre of severe intestinal bleeding, until the lab error was discovered. At age 66 a blood test for prostate cancer was reported as abnormal and confirmed by prostate biopsy. He underwent a course of radiotherapy. During eight years of dietary treatment, kidney function did not worsen; nevertheless, he eventually started dialysis. Despite some complications, he is still doing fairly well, having received a transplant. In retrospect, dietary treatment probably deferred dialysis for about four years.
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