45    years old female pt 
known to have  dm  for the last  18 years 
hypertension for  the last  18  years 
anemia 
ckd 


she  had   bleeding    and she    neeeded  d and   c 
but she  found to have high creatinine 
she   sought medical advice  by  dr    ahamad    and    she  found to have 
next   week  she   sought medical advice  again   and   she  might need  dialysis   a  transplantation 


creatinine   4.2   to  4.5 
plan 
add   alfacal 
add  sodium  bicarbonate 
add  biosolve 
rtc after  2 weeks 
