65   Years old female pt 
free past medical history 
gouty arthritis  for many years 
abdominal pain  for which  she had  abdominal ultrasound   and she  found to have  hernia   and  the kidney  showed increased  echogenecirty 
no chest pain 
no  sob 
no fever  or chills 
she  has  dysuria 

no family history for  chronic kidney disease 
she  was followed by dr naseem alshwiki and  her creatinine was high 