51   years old female patinet 
dm ?    metfromin 

she has  lower limbs edema       maily at the ankles 
she   found to have albuminuria 
she    has   again  lower limbs  edema 

labs showed
albuminuria 56

no  joint pain 
no   skin rash 
no lower limbs edema 

abdomnal us  showed  normal 


plan 
add  cocnor 
add  j dee 
rtc after doing labs and  urine  evalution
i have asked  for  calcium  phosphorus  uric acid 
creatinine 
urine protien  /creatiine ration 
c3  c4  
esr  