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Clinical Crossroads Update
August 17, 2005

A 43-Year-Old Woman With End-Stage Renal Disease, 2 Years 6 Months Later

JAMA. 2005;294(7):841. doi:10.1001/jama.294.7.841

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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