50   years old female patinet 
she was dong well  
free past medical hisotory 
presented with flank pain for the last   one week 
she has  family hsitory   for     renal dsiease 
FSGS 

she   found to have   creatinine  1.  7 
urine protein c/creatinienratio  was  more than 2 

no joint pain 
no  morning stiffness 
no oral ulceration 
no  rheynoid  phenomenem 
she  is  knonw to have   thyroxin  100   mcg once dailyh 