45  Years old female patient 
unknwon to have  chronic  kdiney disease 
presented with  joint pain  for the last   one months 
she has   morning stiffness for the last  one  months 
sleeping 
she has lower limbs edema 


she  has  puffy face  and periorbital puffness 


plan 
add    modal
add j dee 
add deflazacort   half  ta daily for one week 
urine analysis not  done 
creatinine  normal 
abdominal us  normal 
