60  years old female pt 
 dm       For the last    3  years 
htn   for the last     3  years 
dld    for the last  3  years 
tachyarrhthmia   


presented with c/o  
LOWER LIMBSEDEMA 
SHE HAS JOINT PAIN  AND SHE RECEIVED  ETOPAN AND CORTISONE 

she   was refered from dr ameen as  she  found to have  +4  protein  in the urine analysis and she  found to have 
Urine PCR   7200 
nephrotic  range proteinuria 

creatinen  1.05   mg/dl 
urine analysis +4  protein
urine PCR   7400  /DAY 

MEDICATIONS 
valsan hct    160/25
asa  100 mg once 
divinus  10 mg once 
alloril  300  mg once 
concor  mg once 
lipitor  40 mg once 


plan 
rtc   after  2 weeks 
diovan 
lasix 
abdominal us 
labs 
she  came  for    follow  up 

24 hour urine collectio  14 000

plan 
trasfer the pt  to the hospita; for admission and  for pulse steiod therapy and   biopsy