66  years odl male aptient 
dm for the last   5  years 
htn  for the last   5  years 
dld 
stroke  with   with risual  right side ody weakness and   slurred speak
he was maitainen  on  stroke  before   3  weeks 

regarding the kidney   before  2  months he was admitted to the hospital  dr jad and he was trasferred  to the hospital   for  investiation   and  his c reatnine  was  2,3   mg/dl 
he received  iv    untill  improved to  1.6 
  then   he  repeated the tet   and it was 2,3-2.5 
he has    valvuler ehart disease 

he needs  c cath   before   valve  surgery and he needs    to improe his  kidney fucntion 

abdomonal us  was done and showed  both kdiney  increase  in theit  parenchyma 

with  decrease  corticomedullary diff   sufggestiv renal impaitement 

medciation 
cadex
nifidipin 
galvus
omnic 



plan 
rtc after 2 weeks
add  l carnitin 
add   bioslove 
do labs and rtc afer  2 weeks 
ana  c3  c3  esr 

creatinine   