39  years old male pt 
he was doing well untill few   days  ago when he started  to ave  generalzed weakness   and he found to have high blood pressure  reading 

creatinine was done and showed  1.6 

abdominal us  was done and it showed   both  kidney  showed  increase parenchymal   echogenecity  suggestive   of acute   renal impairemen     grad  1  diffuse  fatthy liver infiltration 
gaseous  abdomen 

wbc   8. 18    hgb  15  plr   209 
creatinine    1.58    alt    31   cholestolr   330      ldl   243   uric acid   5,5 

he has history fof  hypertenson  at youg   age 

medications  off 
no joint pain   no skin rash 
no  oral ulceration 
no   lower limb edema 
no  morning stifness 
family history for  maler rash 
no chest pain  or  sob 
no  abdominal  pain  or  diarrhea   
no  eye  prblem  


on exmaintion 


bp   150/90      150/110 
unremarkable physical examination 

impression 
r/o  igA  nephropathy 

consider doing  urine analysis 
might need  kidney biopsy 
he has been maintaine don valadipine   80/5 


add   concor 
add  lipitor 
make valsan  80/5  x2 

consider  doing  gn  work up 
consider kidney biospsy