18 years old male patient 
known to have   sojren syndrome   with positive   joint pain  hair los   eye  dryness  and  skin rash 


kidney us  showed   right side   11.7   9.1
mag 3  shwoed     73%  on the right side and   27% on the left  side 
grad  1  reflux 

creatinine   1.4
medication 
feboxtate 
j  dee 
plaquneil 

labs  showed   ANCA  neagative 
12/2023   1.85  
1/2024   1.32 
2/2024   1.44 
3/2024   1.3 
5/2024   1.3 
6/2024  1.28 
8/2024   1.28 
8/2024   1.42 
c3  noraml 
c4  normal 
ana positive 

11/2024   minimal proteinuria
urine analysis no protein 
hgb  1666
wbc 6.6   plt  193


labs  in 1/2025   showed 
esr 2
hgb  173   wbc   7   plt    205
urine  analysis  negative   for protein
creatinine  1.56
bun 14
sodium 139k   3.9     cloride   106 
protein /creatinine  ratio 0.07  
plaqn  200 mg once 
febox  40
