52  years old male pt 
knonw to have  DM for the last  22  years 
dld 
hypertension 
cad 
arthris 

father with kidney  tx  and passed away 
creatinine before  2  years   was 1,9
urine analysis sowed plus  2 protein 

given atacand and  forxiga before  but  it  rose the creatinine  

today he came for follow up 


today he came for follow up 
creatinine  4.6 
bun high 
hgb 9 

plan 
stop atacand 
stop  forxiga 
add   alfacal 
diet and   water  restirction 
lasix  prn