 Liver function test, ALT was 12, AST 15, albumin 3, TSH of 4.8, and T3 of 1.33.,IMPRESSION AND PLAN:  ,The patient is admitted with a diagnosis of acute on chronic renal insufficiency, rule out hepatorenal insufficiency could be secondary to congestive heart failure, cardiac cirrhosis, rule out possibility of ascites secondary to mesothelioma because the patient has got history of exposure to asbestos and has got pulmonary nodule, rule out diabetic nephropathy could be secondary to hypertensive nephrosclerosis. 
Liver function test , ALT was 12 , AST 15 , albumin 3 , TSH of 4.8 , and T3 of 1.33.,IMPRESSION AND PLAN : , The patient is admitted with a diagnosis of acute on chronic renal insufficiency , rule out hepatorenal insufficiency could be secondary to congestive heart failure , cardiac cirrhosis , rule out possibility of ascites secondary to mesothelioma because the patient has got history of exposure to asbestos and has got pulmonary nodule , rule out diabetic nephropathy could be secondary to hypertensive nephrosclerosis .