63   years old male pt 
HTN    For the last  15 years 
DM  for the last   15  years 
he has  pleural effusion   for the last   one  month afte chest  x  ray and  chest  ct 
last chest infection  29/12/2024   and he was admitted  to hospital   for  24  days 
and he had c cath      with one stent and then he  needed another   c cath 
creatinien at that time  1.7 mg/dl

he has   sob  on exertion 

he was referred from dr  khalil krem and  dr maswadah for   futher  evalution and manaement