59 years old male pt 
known to have  DM  SINCE 2003  HTN  DLD  HI  TRI , CHF   AF NORMAL CONRONARIES 
He has   tisticuler ca  in 2003 and he received chemotherapy   
he has acute kidney injury before  4  years and is  creatinine  peaked to 5    then improved to  2.5 

he was referred from  dr  neveen   for  kidney evalaution 
creatinine  now  3,5 
edema 
no uremic manifistation 
no serum lytes  or  urine analysis 


impression 
cardiorenal syndrone 
diabetic nephropathy 

plan 
add alfacal 
add  calcium 
add  amicor  sicne his blood  pressure  160/77 
decrease the dose of  quest  to 2.5 mg 1x2 
reevaluation after labs 