Leigh Dell, age 73, has never been to Johns Hopkins, because he lives too far away. He has had protein in his urine for many years (perhaps as a result of taking Advil over a period of years following a leg fracture). He learned in August 1999 that his serum creatinine level was elevated (to 2.9 mg per dl) and his serum urea nitrogen level was 58 mg per dl (normal is less than 25 mg per dl). His wife, after some reading, decided to start a low-protein diet and tried to assemble an essential amino acid mixture from individual amino acids sold at the health food store. A renal dietitian they saw told him to discard the amino acids and to eat 60 g per day of protein. His serum creatinine increased to 4.1 mg per dl. His wife located a complete mixture of essential amino acids (Nutramine) and also put him on a 23 g protein diet. His energy increased markedly, and he managed to lose weight. They found a nephrologist, who advised against the program they were following and recommended that he instead take 70 g of dietary protein per day. The nephrologist also said that Leigh should get ready for dialysis. However, the couple persisted with dietary treatment.
By October 29, 2002, Leigh's serum creatinine level was back down to 3.5 mg per dl and his serum urea nitrogen level was 32 mg per dl. Serum albumin level is normal (3.9 g per dl). His nephrologist now tells him that it may be possible that he will never need dialysis. Leigh is currently consuming between 40 and 50 g of protein per day and taking 10.5 g of amino acids per day. He has no symptoms, and plays tennis, gardens, and goes to the gym.
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