29    years old female pt 
2  months ago she  suferedf rom flank pain 

she  sought medicala dvice at  gyne and she   had   urina anlysis  that showed  high wbc  as  she said 
she  received  iv   rocephin and     and then she  had   urine cultures 

then she had  creatinine     which was normal  but she   found to have proteinuria 

then she   started to notie  periorbital puffness 
she  has    joinpain and  mornign stiffness  
small  joint   pain 
no eye  redness 
she  reported   oral ulceration      multiple  times 
she has abdominal  pain  
no  diarrhea 
no constipation 

no  skin    rash
  she  has  chest  discomfort 
no cough 
no  sputum 

she  reported long  standing history for  dysuria 

she has  dysmenorrhea 


no fever   and no  chills 


-----------------
family 
mother  with  htn 
sister  with  rheutological  disease    but  she has   facial eczema 

medications 
off medication 

she has    one  daugther and  2  son 
no history  for  preclampsoa 
---------------------
on physical examintion 
bp  99/60  hr   normal 
on physical examintion  unreakrable 
trce lower limbs  edema 
joint   tendneress 

--------------------
labs  showed 
wbc     7   hgb    12   plt   159
no proteinuria  in    10/2024


plan 
do renal us 
do ana   c3  c4   esr   urine analysis 
ciprofloxacin if    uti 
if  not then   urine protein /creatinine r ation 

cosnider  further  work  up for the proteinuria 

rtc after  finshing the  drug 
4/2025  she  had   +3  wbc  +1  protein 
rbc    36-28
creatinine   0.7   bun    18    ast  alt  nl