54   years old male pt 
knonw to have 
dm   for the last   25  years 
htn  for the last   10  years 
 c cath and  stent   before  3  years 
no  rcent  echo 

presented with lower limbs  weakness 
medication 
lantus     35  iu   x2
apidra   10  iu  3  times
asa 
mepral   20 mg onc 
liponil 40 mg once 
exforg   160/5   stopped     before   5  days  and  they switched to amicor 
alloril  100 mg once 

before  10 days   his wife   died and he started to have  lower limbs  edema 
and then he  sought medicala dvice  by dura hospital and he  found to have  creatinien 6 
before   3  months   it was  3 and  before  than  it was 2.6 