60   Years old female pt 
htn   for the last  15  years , hypothyroidsim  for the last   7    years ,  cardiomyopathy 
arhythmia   before  2  years  
DM   diagnosed before  2  years 
DLD 
Gout  before   4  years    she has  c cath    for arrhthmia 
at that  time  her creatiine  was  1,6 mg/dl  improved  to 1.3 


this yeas   her creatinine    was  1.3  
increased in ramadan  1.6 
recently  she  did   creatinine  1.66 

medications 
codiovan    160/12.6 
lipitor   40 mg once 
asa  100 mg ocne 
cocnor  5mg  once 
amoidaroj n 200 mg  half  tab daily 
pantover  40 mg ocne 


plan
do  labs 
do    urine protien  /creatinine ratio  
do  renal us 
stop  co  diovan 
add   exforg 


rtc aftger  doing labs and after  doing  renal us 
exforg   160/5 
dee d esne 
add  dee  dense    200  iu  once daily