58  years old female pateint 
hypothyrodidim      since 12  years 
dM  for the last  10 years 
hypertension  for the last 10  years 
dlD   for  long period of time 


medications 
thyoxon   200

liponil  40 mgonce 
valsan  hct      160/25 
movalis 
amicor  5mg 
hypocor   5 mg ocne 


according to dr  hani  she has   hematuria and heavy proteinuria  
last  eye exam  not  consistant  with DM changes 


she has  long  standing  history for joint    pain and  morning  stiffness 
no  skin rash 
no oral ulceration 
no   git  manifistation 

no history for hematuria 

last labs showed wbc   7,8  hgb  12.5  plt274
ldl  103
creatinine 1.12 acr 11548
urine analysis   hematuria   and proteinuria

plan 
reevalaution after  us and labs  for kidney biopsy 
to  come  tomorrow  to the hospital  for kidney biopsy 
follow up blood  pressure 