In nephrology health care the aim is often to preserve residual renal function for as long as possible to optimise health, improve outcomes and enhance lifestyle. However, in some cases, this preservation may cause significant morbidity and mortality. In these circumstances, nephrology health care must be tailored and delivered outside our routines to meet the needs of the individual.

In Dec 2006, a 54 year old man was referred to North West Dialysis Service(NWDS) with membranous glomerulonephritis and nephrotic syndrome. On admission, his serum albumin was 16g/dl, eGFR 25. He felt tired and depressed, experienced some pain and at times severe shortness of breath. He was obese at 114kg.

Plasma exchange was instituted over 15 weeks to reverse his nephrotic syndrome. However, his albumin failed to respond. To correct his persistent and morbid hypoalbuminaemia, he was prescribed a non-steroidal anti-inflammatory agent and commenced dialysis to sacrifice residual renal function.

The medical team, the acute, regional and home dialysis nurses supported this gentleman through the stages of his illness and treatment regimes to progress to nocturnal dialysis where he has regained both normal albumin (38g/l) and his independence.

This case study illustrates the extraordinary journey of a 56 year old man from a very difficult and restricted life with nephrotic syndrome to what ultimately proved to be a much healthier and happier life on dialysis. It highlights the importance of individual treatment plans to maintain the best interests of the patient.