28  years old male pt 
free  past medical 

6  years ago he   started to nave  hematuria 
he  was  followed by  dr   wadee3  
abdoninal  us  and cystoscopy was done    with  unremarkable result 



few  days   ago he  started to have    fever  and chills assocoated with    hematuria 
he has  joint pain   with morning stiffness
no skin rash
oral ulcertion   multipe  time 
stable weight 


no family  history for  renal disease 




abdominal us  showed icnrease   renal echogenecity 
wbc    14.5  hgb    14.6  plt     449 
urine  analysis showed   many  rbc  and   
no  wbc 

plan 
rocephin  in  normal  saline   500   for   3  days then   to contiunue  on ciprofolxacin 
to do  ANA   aNCA   ESR    URINE  PCR   CREATININE   
CONSIDER  KIDNEY BIOPSY AFTER   GETTING  FINANCAIL COVERAGE 

THANKS 
