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Neurological symptoms: referral to a haematologist, with injections often around every two months

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These patients may also be presenting symptoms of myopathy, retinopathy, optic atrophy, sensorineural hearing loss, and hypertrophic cardiomyopathy

The causes are varied: heredity, hormonal fluctuations, stress, an unbalanced diet or skin ageing

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There is currently insufficient evidence on how to sequence the remaining evidence-based medications, so we suggest that the choice of additional kidney protective medications be predicated on individual values and preferences and the willingness or ability to take additional therapy