6  years old ago he has  renal stone   that had passed   alon 
he has  recurrent  stone and passed 


before   2  weeks  he  started to   have fever   and chills 

he  drunk alot  of fluid and then  he started to  feel lower limb edema 

he  sought medical advice  at  dr amin harb 

he has  lower limb edema 
nausea and vomiting 


medications 
diclufen    75 mg   frequently 

no family history for renal disease 
knee pain  with  no morning stiffness 
no oral ulceration 
no skin rash 
no chest pain   but recently he has  sob 
stable  weight  but recently he has  lower limb edema  and increase  appitis 

labs showed 

abdominal us showed    normal gall bladder 
normal common bile duct 
spleen normal 
few  non obstructive stone in the lower pole  of the kidney  the largest measures  about  12  mm 
no  evidcane of obvious stone   ain the lower pole of the left kidney 
no hydronephrosis 
right kidney  11.5 left kidney  11.5
mild amout of  abdomina  fluid 
mild bilateral pleural effusion 


labs 
7/2    wbc  6.8   hgb    15   plt   410
creatinine  2.4    bun  39 
urine analysis showed  protein +1   abd    wbc  8-10  
no  rbc 



plan 
admission to the hospital 
solumedrole   1 gram daily 
anca   test 
antigbm 
revalaution after labs 