LS presented in 2008 with proteinuria and abnormal renal function (?? What) at the age of 30. A biopsy was undertaken, which revealed a late, severe focal segmental sclerosing glomerular disorder. LS’s past medical history included an imperforate anus that had been corrected as a neonate, dysplastic ears but no thumb malformations. He also had a history of hypertension, osteoarthritis and  migraine. Chronic kidney disease progressed necessitating renal replacement therapy and LS had a pre-emptive renal transplant in October 2011. Proteinuria continued following transplantation, and increased further on conversion of mycophenolate mofetil (MMF) to sirolimus; switch undertaken due to CMV colitis and persistent CMV viraemia. A renal allograft biopsy was undertaken at this point which showed acute cellular rejection, treated successfully with methylprednisolone. Acne was induced by sirolimus, the tetracycline used to treat acne caused cerebral hypertension and so he was converted back to MMF. LS developed new onset diabetes after transplantation in 2015. He also has some mood disorders and suffers from severe anxiety and does not like to talk about his medical condition.