73  Years old male pt 
Known to have 
DM     since 1990
HTN     2010 
DLD 
Gout
Hernia 
CABG 2007 

Chronic kidney disease  (   he had 2019   forgin body )   and he  has    many operations 
  It was   1. 5   in 2019  and  then it reached  2.9

Before  2  days   it t came  back  4.9

Exercise tolerance  300  km 
Exertional sob 
He has lower limb edema 
Urine  no dysuria   no urgency 
Abdomen:   no abdominal pain   no  diarrhea or constipation 

Medication
Cdex   2  mg   once 
Mepral;    20 mg once 
D  3  once daily 
Calcium
Alloril  100 mg once 
Asa   100 mg once 
Amicor   5 mg once
Spiron  25 mg once 
Isomizide 
Lasix  40 mg once
Concor  5 mg once 
Lipitor    40 mg  once 
Mixtard  20 +10 
Betastin 1 6 mg once 

Labs 
Showed   uric  acid  9.4
Wbc   5/16  hgb  10.3    plt   168
Bun 7
Cholesterol   157
Creatinine  4.53
Dll  100 
Hdl  32
Alkalin  83
Alt  15
Hba1c   78

Gfr   15 

Plan 
Stop amicor 
Stop aldacton 
Do serum lytes
Medrol  4 mg once daily for 5  days 
Make mixtarx  25  and  15 
Do labs after  2 weeks and  then to be reevlauted 

Urine analysis 
Cbc 
Serum lytes 
Alt 
Albumin
Esr 
12/5  VISIT 
TODAY HE WAS SEEN AND HIS CHART WAS REVIEWED 
CREATIINE  4.6 
NO UREMIC MANIFISTATION 
PLAN 
CONTINUE  GUNA  KIDNEY 
CONTINUE  ZIMICAL 
CONTINUE  FERRUS  FUMARTE 
RTC AFTER ONE MONTH 
----------------------------------------------------------------------------------------
15/1/2025
creatinine  4.7    uric acid   6.6     cholesterol   147 
glucose   172
wbc   6.7  hgb  9.6   plt   257

it  was    3.6     in june  2024



PLAN 
STOP  CADEX  
KEE THE SAME  
ADD  BIOSOLVE 
RTC AFTER  2 WEEKS 
HE HAS  LOWER LIMB    EDEM AND   INFECTION AND HE IS ON AURGAMITIN