17   years old   female pain 
presented with  flank pain 
urine analysis   showed  protien /creatinine  ratio   183/227 
creatinine  0.65 
bun  11

wbc 9.3   hgb  14,6  plt275
she has  mild prtein uria 

add l  carnitin 

plan 
abdominal us 
labs 
reevalaution 
l  carnitin 
zimical 