At Medical Grand Rounds in January 2003, Glenn Chertow, MD, discussed
a 43-year-old woman with end-stage renal disease as she considered renal replacement
therapy.1 Mrs C had had renal insufficiency
for 23 years and carried a diagnosis of focal segmental glomerular sclerosis.
Her only symptom of renal disease was fatigue, which was improving with erythropoietin
therapy. Despite this, her laboratory markers were steadily worsening, and
over the months prior to the conference, Mrs C’s nephrologist had begun
to discuss her options regarding treatment. She had failed to find a relative
who might provide a donor kidney, and at the time of the conference had chosen
to prepare for hemodialysis and fistula placement.
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