today he came for  follow up 
he looks  better 
creatinine 1.9  the same   and  didnot increase sicne the last vist  after adding  atacand 
he  took   20 mg prednisone for his left  elbow pain with  mild improement 
his proteinuria  is  aroudn 400 

plan 
rtc after one month with  all labs   then consider adding sglti  inhibitor  if indicated 

consider kidney biopsy in the future if indicated