24  years old male pt 
unremarkable past medical history 

he  started to have   frothy  urination for the last  few  months 
anorexia 
decrease   excercise tolerance 
weight  loss 
nocuria   for the last  2  months 
good  amount of  urine out put 

for the last  one  years   he  has   joint pain and  bone pain 
one  years   morning stiffness 
no  skin  rash 
no oral ulceration 

he was  using   acamol and  other  analgesia 

labs  showed 
wbc   6.7   hgb   12.7   plt    283
esr  27
creatinine   5,46 
bun   132 
k  4,8 
na  136
chloride   104 
ast  12
serum albumin     4.27
fbs   84
cholesterol 229
uric acid 7.2 
ldl   135
calcum 9.8
tsh  2.2 
urine  analysis  showed   rbc    65-70         +3  protein 


renal  us  was done and  showed 


rigth side 12  cm thin  cortex       1  cm 
left    kidney  12.5   1.5-1.8