60   years old male pt 
BPH 
HYPOTHYRODISIM 
DM   X  20 
HTN  X20 
DLD   X20 
IHD    WITH OPEN HEART      BEFORE  3 MINTHS    DONE BY  DR  NIZZAR 
BEFORE  5  MONTHS  HE STARTED TO HAVE  LEFT FLANK PAIN AND   GENERALZED WEAN ESS 
BEFORE  4  MONTHS    HIS CREATININE  3   AND THEN   HE HAD    OPEN HEART SURGERY 


BP  150/70 
HR 
LAST  LAB  IN 21/8  HIS CREATININE    FOUND 
HE  WENT TO JORDAN AND   THEN    HE    FOUND TO HAVE  CREATININE  7 MG/DL 
AT ALISTISHARI  THEY  ASKKED HIM TO  DO  DIALYSIS  BUT THEN   HIS  CREATININEN    IMPROVED TO  5,13 


EJECTION FRACTION  50% 

CREATININE  5-7 MG /DL 
HE HAS  MILD LEFT  SIDE   FLANK PAIN


PLAN 
DEFLAZACORT 
ALFACAL 
SODIUM BICARBONATE 
ABDOMINAL US 
AFTER   DOING LABS 
