70   years old femle pt 
dm x2 
htn 
gout 
hypothyroidism 
ckd  1.4-  1 


creatinine   1.7 
uric  acid   5 


medications 
nevantin
alfacal 
nexium 40 mg once
liponil 40 mg once
alloril  300 mg once 
moduril
pracetamol
galvus
concor  
asa 


plan 
do urine analysis and urine pcr 
do  pth 

plan 
consider  adding 
consider   sglti 
make alloril 100 mg once 