63   years old female patient 
knonw to have    goutyarthritis 
htn    


medciation 
norvasc 
alloril   300 mg once 
vit  d 

free   review  since she  has   100  payment
biosolve 
herbex 


creatinine   1.28 
uric acid   5.6


abdominal us  snowed  normal kidney size and echogenecity 
11 cm    in length   both  showed   heterogenous   increased   parenchymal  echogenecity   with numberous  of  punctat  cortical echogenecity  foci 
bilateral renal gravels 
few   cortical   thickness being  around  10-111  cm 

wc   7   hgb    13    plt 215
creatinine  1.14
wbc     5.5    hgb  13    plt    230
creatinine   1.3
uric a cid   5.7
urine analysis showed negative for protein  and   normal  wbc



plan 
do  work up for the autoimmne  disease 
r/o  rta 
pth  disease 

rtc after doing labs 

