19  years old  male patint 
the  history started at the age of  5  years  old  when he  developed   nephrotic syndrome 
creatinine at that time was   0.5
  labumin  3.2 


then he sought medicala dvice   at the  age of  7  and he was prescribed    10/2010
kidney biopsy was  done and showed  19 glomeruli   are  available  negative for  iga  negative  for igg   igm  c3 c4   and fibrinogen 
consistnt with MCD 


DVT   UPPER LIME   ON ELIQUIS 

PREDISONE  AND  CYCLOSPORIN 
CYCLOSPORIN WAS GEVEN FOR 4  YEARS  WIH  GOOD CLINICAL RESPONSE 
THEN  IT WAS SWITCHED TO  CELLCEPT  500 NG  1X2   FOR ONE  YEARS

OFF  CELLCEPT    FOR THE LAST  4  YEARS 
OFF  CYCLOSPORIN  FOR  THE LAST  6 YEARS 
2023  3  TIMES
2024    3  TIMES 

PLAN 
DIOVAN   160 MG OCNE 
DEE DESNE 
CALCIVITA 
PREDNOEN  35 MG OCNE 

CONSIDER  ADDING PROGRAF   AFTER ONE WEEK 
CONTINUE   ELIQUIS  FOR   3  MONTHS AT LEAST 
ADD   LIPITOR   40 MG ONCE DAILY AND FOLLOW UP LABS  AFTER  ONEN MONTH 

RECENTG   MEDICAITON 
PREDNONE  35 MG OCNE DAILY 
DEE  DENSE 
FAMODIN A
CAMOL


HBA1C  5,1
WBC15,3  HGB11.9  PLT461
PCR 4 GRAM
CREA0.4
ALBUYMIN  2,2
LDL   284
NA138

ESR 95
TSH NL
FERRITIN 116
C3 C4 NEGATIVE
VIT D 3.8
