54  years old    female  patient   knonw to have leukemia   trasfformed to lymphoma 
she has  chronic kidney disease  discoved in 2022   when it was  1.3 
she was referred to do kidney biopsy  but due to risky procedure it was cancelled 
then  she was on reguler follow up   but  with no close labs monitring 
2023  she has spleenectomy 

today she came with creatinien  3.02      but  before one month it was   4 
she had  abdominal us  that shwoed   small  size of the bother kidney   right side   7.6    and the left  side   7   with cortical thickness   6.4 mm  and 5.8 mm 

she was seen by  dr sameer  before and he prescribed  steriod to her   staring by 60 mg but she was  taking  40 

plan 
tapering the steriod down 5  mg  q week 
add  bicarbonate 
add   biosolve 
continue  calcium alfacal  and lipitor