74   years old male pt 
htn    
ihd 
dld

2010   he had  kidney  problem 
 stone a  that had bee   operated 
  creatinine at tbat time  was 


2  years   ago  he  had   


for the last  2   months  he started to have  lower limbs edema 
seen by dr sameer   zawahrah 
hematology  evalaution   asked for   biopsy



4/2025   his creatinien was   3,3  and  the  albumin   2, 7 
urine analysis  showed +3


repeated us  was normla 
ana     negative 
anca  negative 
est   always   less than 20 

creatinine   more than  4 

reeapted renal us  norma;



plan 
add  aransp 
add  hydralazin a
dd  monocord 
add aldopa 

rtc after one month 
consider   kidney  biopsy