 45  years old female 
since the age of   17  she  has  proteinuri and hematuria 
she  has   chronic kidney disease 

ig  
2013  she  has   kidney biopsy that   showed   20%  fibrosis 
and  now  her creatinine  4 

medications 
valsartan   and amlodipin  160/10 
calcium 

plan 
consider  referaal  for  avf
do  labs   at the hospital