55  years old  male ot 
dm 
htn 
ckd  base line creatinine  2,-2,4 

presented  today  with creatine  2.9
bunn45 
hba1c 8.4
alt    15 
cholsterol 177
uric acid 10
wbc   5,5   hgb 11.3 plt   127

plan 
consider adding entresto 
add  hydralazin 
make  aldactone   halt  tab daily