58   years old male pt 
known to have  hypertension   for the  last  8 years 

gouty arthritis 
base line   1.9-  2 
for the last      4  years  he  suffered fromn   right  wrist pain and swelling and he w as diagnosed with psedogout   

he  sought medical advice  by dr  idies  and  he was   was  discribed   feburic       40 mg once 
  then  80 mg once 
colchivin  0.5 mg   1x2  
medrol 4 mg once 
he   found to have   polycythemia  

creatinine
creatinine 2.2
crp negative
mg 1,8
rf  negative
wbc  12.8   hgb  17.5  plt  227
uric acid  3 
fbs   90    creatinien  2.18

kidney us  showed polycystic  kidney disease 

codiovan  160/25 mg once 
colchcin 
feburic 
steriocort 
rivoxar  20 mg once efburic 


