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STUDY: A PATIENT WITH CHRONIC KIDNEY DISEASE Gary is 49 years old and is an active man who works at a large manufacturing plant. Recently, he has begun to tire more easily, has little appetite, has lost 5% of his normal body weight, and he generally feels ill most of the time. He recently noticed some ankle swelling and blood in his urine. At his family's insistence, he finally decided to see his physician. After a complete workup, the physician's findings included the following: No prior illness except a case of the flu with a throat infection during his overseas service in the Army Laboratory tests: presence of albumin, red blood cells, and white blood cells in the urine; high blood potassium, phosphorus, creatinine, and urea levels; and a severely decreased glomerular filtration rate of 20 mL/min per 1.73 m² Other symptoms: hypertension, edema in the lower legs, headache, occasional blurry vision, and low-grade fever The physician discussed the findings and the serious prognosis of stage 4 chronic kidney disease with Gary and his wife. Together with the renal dietitian, they explored his immediate medical and nutritional needs. They also discussed the ultimate need for medical management with dialysis or transplantation. The physician prescribed medications to control Gary's growing symptoms and discomfort. Over the next 10 months, Gary's symptoms worsened. He lost more weight, became and had increased bone and joint pain. His nausea increased, and he had occasional

STUDY: A PATIENT WITH CHRONIC KIDNEY DISEASE
Gary is 49 years old and is an active man who works at a large manufacturing plant. Recently, he has begun to tire more easily, has little appetite, has lost 5% of his normal body weight, and he generally feels ill most of the time. He recently noticed some ankle swelling and blood in his urine. At his family's insistence, he finally decided to see his physician.
After a complete workup, the physician's findings included the following:
No prior illness except a case of the flu with a throat infection during his overseas service in the Army
Laboratory tests: presence of albumin, red blood cells, and white blood cells in the urine; high blood potassium, phosphorus, creatinine, and urea levels; and a severely decreased glomerular filtration rate of 20 mL/min per 1.73 m²
Other symptoms: hypertension, edema in the lower legs, headache, occasional blurry vision, and low-grade fever
The physician discussed the findings and the serious prognosis of stage 4 chronic kidney disease with Gary and his wife. Together with the renal dietitian, they explored his immediate medical and nutritional needs. They also discussed the ultimate need for medical management with dialysis or transplantation. The physician prescribed medications to control Gary's growing symptoms and discomfort.
Over the next 10 months, Gary's symptoms worsened. He lost more weight, became and had increased bone and joint pain. His nausea increased, and he had occasional

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