38 years old male pt 
2029  he has  lower back pain   and he found to have  retroperitoneal fibrosis 

he  underwent   bilateral  djs 
lasted fro  5 month 


then another   he   needed another  djs 

he  was maintaned on MTX    AND VIT  D 
prednisone   30 mg once 

since   2021  he is  off medications  and  off medical follow up 
he was  doing infrequent labs 

today he  complaining  from low back pain and  dysuria  now 
he had  itching 


lDL   121
eRS 6
HBA1C   4.6 
NA   137    K  4.2   CL  101 
CREATININE1.15 
BUN21
URINE ANALYSIS   CLEAR

abdominal ct   showed  retroperiptoneal fibrosis ,   and the right kidney showed  8,5  cm 

creatninine  in 2021   1.4
esr  3
aNA  AND  ENA  AND  ANCA   were negative
rf negative


last  ct  was done  in 23/7/2024   that showed 
small  soft tissue   density area around the  aortic  biforcation and iliac artery  with uretic  mediastinal is  seenin keeping with  retroperitoneal fibrosis 

the right kidney  is small  in size   6,4 in  bilpoler length
the   left kidney  12  cm 
5/2024  creatinine was1,4
creatinine 1,1
k  4.3   
ldl 149
urine analysis  negative  for active urine sediment

12/2024
creatinine  1.48
urine analysis   no active urine sediment

plan 
eSR 
lipid  profile 
creatinine 
urine analysis 
ha1c 

rtc  to consider adding muscles relaxant   and medrol
coniser   switching  amicor   5 mg 1x1
dee  dense   2000  iu once daily 
consider  referral to dr muath tomizah