24  years old female patient 
4  years  ago she  found to have proteinuria 
renal ultrasound showed   refux  on one  side 
she  was referred fro zighan for evluation 

proteinuria     +2 

plan 
i asked her to do labs  and then  to be reevalauted 
add   atacand   8 mg  half  tab daily and then   1  tabs 
add   vi t  j 
if  having  high proteinuria    then to consider  biopsy 
to  do limited  autoimmune  owrk up 