A 58-year-old African American man with a medical history of hypertension, tobacco use, and gout presented to the nephrology clinic after laboratory studies revealed a serum creatinine level of 10mg/dL. He noted anorexia, nausea, and dysgeusia associated with a 40-pound weight loss during the past year along with fatigue and mild dyspnea on exertion, but no edema. He had no family history of kidney disease. Medications included aspirin, bupropion, calcitriol, labetalol, nifedipine, and sodium bicarbonate.