CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 2749**] is a [**Age over 90 **]yoF with severe diastolic HF NYHA class IV
with multiple exacerbations in past year, HTN, HLD, Afib, and
gait abnormality related to ?DM who presented from home on [**2-13**]
after sustaining a fall 3 day before. Her fall was unwitnessed,
but was thought to be mechanical, as pt tripped while getting
out of bed to the commode.  L hip pain developed over the next
few days, and her family brought her to the ED.  CT scans of the
cervical spine and head were negative for fracture or bleed. A
plain film of the hip showed chronic fractures of the left
superior and inferior pubic rami but no new fractures.  UA was
concerning for UTI, she was started on macrobid.  She was
subsequently transferred to the floor.
.
On transfer to the floor, her VS were 98.2 128/70 98 18 98/4L.
She was without acute complaints initially.  Her antibiotics
were broadened to linezolid and cipro on [**2-15**].  On the evening
of [**2-15**], she triggered on the floor for desaturation to 88% on
2-3L; came up to 94-95% with 5L O2.  At baseline, she is in the
low 90s on 2-3L at home.  She got lasix 60 IV x1 (takes
torsemide 100 [**Hospital1 **] at home, but has been off since presentation
due to hypotension), mucomyst, morphine 0.5, and nebs. Repeat
lasix 40mg IV x1.  ABG 7.51/45/51/37. HR was noted to be in the
120-130s (home B-blockers also stopped secondary to
hypotension), got lopressor 5mg IV x 2 with little effect.
Attempted to put her on face mask for mouth breathing, but
patient kept ripping it off.  Pt was also complaining of chest
pain, and was felt to have altered mental status and increased
agitation.  Pt was trasferred to the MICU for further
management.

MEDICAL HISTORY: - Chronic diastolic heart failure, last EF 65% ([**7-/2168**])
- Hypertension
- Dyslipidemia
- Atrial fibrillation (not anticoagulated due to fall risk)
- Microvascular disease
- Extensive basal ganglia disease
- Gait disorder
- Advanced degenerative joint disease
- Meniere's disease
- Hard of hearing

MEDICATION ON ADMISSION: 1. diltiazem HCl 240 mg Capsule, Sustained Release daily
2. metoprolol succinate 150 mg daily
3. phenytoin sodium extended 300 mg daily
4. aspirin 325 mg daily
5. ursodiol 300 mg [**Hospital1 **]
6. polyethylene glycol 17grams daily prn constipation
7. senna 8.6 mg [**Hospital1 **] as needed for constipation.
8. docusate sodium 100 mg [**Hospital1 **]
9. torsemide 100 mg Tablet [**Hospital1 **]
10. potassium chloride 20 mEq daily

ALLERGIES: Iodine-Iodine Containing / Ampicillin / Phenergan Plain /
Zaroxolyn / Ambien

PHYSICAL EXAM: Admission Physical Exam:
VS - Temp 98.2F, BP128/70 , HR98 , R18 , O2-sat98 % 4LNC dry
weight 60.4 kg
GENERAL - fatigued appearing elderly female in NAD
HEENT - bruising around right orbit with swelling, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, JVD to 8cm
LUNGS - bibasilar crackles appreciated
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials,
DPs). Pain on palpation of the feet bilaterally.
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, alert, oriented to person and place. Poor
compliance with neurologic exam, though CN were intact
bilaterally. Strength 5/5 in all extremities. Normal sensation
to light touch in all extremities. Patient declined getting out
of bed for gait assessment and orthostatic vital signs.

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient lives at home by herself at subsidized senior housing in
[**Location (un) **] with assistance from family. She has a 24 hour care
worker that watches her 5 days a week. Her daughter watches her
the other 2 days each week. Her Grandson [**Name (NI) 382**] is an interpreter
at [**Hospital1 18**] and is very active in her care. Granddaughter is ?also
HCP. Aids help her with cleaning and shopping. No smoking or
drinking.
Atrial fibrillation,Pain in joint, pelvic region and thigh,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary tract infection, site not specified,Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Delirium due to conditions classified elsewhere,Abnormality of gait,Black eye, not otherwise specified,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified
Atrial fibrillation,Joint pain-pelvis,Epilep NOS w/o intr epil,Urin tract infection NOS,Acute & chronc resp fail,Ac on chr diast hrt fail,Pneumonia, organism NOS,Food/vomit pneumonitis,Acute kidney failure NOS,Hyperosmolality,Delirium d/t other cond,Abnormality of gait,Black eye NOS,Syncope and collapse,Fall from slipping NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS
Admission Date:  [**2169-2-13**]              Discharge Date:   [**2169-3-2**]


Service: MEDICINE

Allergies:
Iodine-Iodine Containing / Ampicillin / Phenergan Plain /
Zaroxolyn / Ambien

Attending:[**First Name3 (LF) 2763**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
Ms. [**Known lastname 2749**] is a [**Age over 90 **]yoF with severe diastolic HF NYHA class IV
with multiple exacerbations in past year, HTN, HLD, Afib, and
gait abnormality related to ?DM who presented from home on [**2-13**]
after sustaining a fall 3 day before. Her fall was unwitnessed,
but was thought to be mechanical, as pt tripped while getting
out of bed to the commode.  L hip pain developed over the next
few days, and her family brought her to the ED.  CT scans of the
cervical spine and head were negative for fracture or bleed. A
plain film of the hip showed chronic fractures of the left
superior and inferior pubic rami but no new fractures.  UA was
concerning for UTI, she was started on macrobid.  She was
subsequently transferred to the floor.
.
On transfer to the floor, her VS were 98.2 128/70 98 18 98/4L.
She was without acute complaints initially.  Her antibiotics
were broadened to linezolid and cipro on [**2-15**].  On the evening
of [**2-15**], she triggered on the floor for desaturation to 88% on
2-3L; came up to 94-95% with 5L O2.  At baseline, she is in the
low 90s on 2-3L at home.  She got lasix 60 IV x1 (takes
torsemide 100 [**Hospital1 **] at home, but has been off since presentation
due to hypotension), mucomyst, morphine 0.5, and nebs. Repeat
lasix 40mg IV x1.  ABG 7.51/45/51/37. HR was noted to be in the
120-130s (home B-blockers also stopped secondary to
hypotension), got lopressor 5mg IV x 2 with little effect.
Attempted to put her on face mask for mouth breathing, but
patient kept ripping it off.  Pt was also complaining of chest
pain, and was felt to have altered mental status and increased
agitation.  Pt was trasferred to the MICU for further
management.

Of note, she is [**Hospital1 **] speaking only; per her daughter, she has
not had any decreased interaction or confusion. The patient
lives in subsidized senior housing and has 24/7 care. The
daughter notes a slow decline in her functional status since a
[**2169**] admission for MRSA pneumonia in which she was
temporarily intubated. She was recently admitted in [**Month (only) 1096**] for
CHF, and per the daughter, has not fully recovered functionally
since. She has had multiple previous falls in the past related
to neuropathy and already unsteady gait.

Past Medical History:
- Chronic diastolic heart failure, last EF 65% ([**7-/2168**])
- Hypertension
- Dyslipidemia
- Atrial fibrillation (not anticoagulated due to fall risk)
- Microvascular disease
- Extensive basal ganglia disease
- Gait disorder
- Advanced degenerative joint disease
- Meniere's disease
- Hard of hearing

Social History:
Patient lives at home by herself at subsidized senior housing in
[**Location (un) **] with assistance from family. She has a 24 hour care
worker that watches her 5 days a week. Her daughter watches her
the other 2 days each week. Her Grandson [**Name (NI) 382**] is an interpreter
at [**Hospital1 18**] and is very active in her care. Granddaughter is ?also
HCP. Aids help her with cleaning and shopping. No smoking or
drinking.

Family History:
NC

Physical Exam:
Admission Physical Exam:
VS - Temp 98.2F, BP128/70 , HR98 , R18 , O2-sat98 % 4LNC dry
weight 60.4 kg
GENERAL - fatigued appearing elderly female in NAD
HEENT - bruising around right orbit with swelling, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, JVD to 8cm
LUNGS - bibasilar crackles appreciated
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials,
DPs). Pain on palpation of the feet bilaterally.
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, alert, oriented to person and place. Poor
compliance with neurologic exam, though CN were intact
bilaterally. Strength 5/5 in all extremities. Normal sensation
to light touch in all extremities. Patient declined getting out
of bed for gait assessment and orthostatic vital signs.


Pertinent Results:
Admission Labs:
[**2169-2-13**] 09:58PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.009
[**2169-2-13**] 09:58PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-LG
[**2169-2-13**] 09:58PM URINE  RBC-16* WBC-92* BACTERIA-FEW YEAST-NONE
EPI-<1
[**2169-2-13**] 09:58PM URINE  HYALINE-18*
[**2169-2-13**] 09:58PM URINE  MUCOUS-RARE
[**2169-2-13**] 01:30PM   GLUCOSE-117* UREA N-32* CREAT-1.1 SODIUM-139
POTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-33* ANION GAP-13
[**2169-2-13**] 01:30PM   estGFR-Using this
[**2169-2-13**] 01:30PM   cTropnT-<0.01
[**2169-2-13**] 01:30PM   PHENYTOIN-8.1*
[**2169-2-13**] 01:30PM   WBC-7.0 RBC-3.50* HGB-11.0* HCT-32.2* MCV-92
MCH-31.5 MCHC-34.1 RDW-18.3*
[**2169-2-13**] 01:30PM   NEUTS-75.2* LYMPHS-16.4* MONOS-4.5 EOS-2.8
BASOS-1.2
[**2169-2-13**] 01:30PM   PLT COUNT-218

Discharge Labs:

Notable Labs:
[**2169-2-13**] 01:30PM BLOOD cTropnT-<0.01
[**2169-2-14**] 06:50AM BLOOD CK-MB-2 cTropnT-<0.01
[**2169-2-16**] 12:10AM BLOOD CK-MB-1 cTropnT-<0.01
[**2169-2-16**] 05:01AM BLOOD CK-MB-2 cTropnT-<0.01
[**2169-2-18**] 03:34AM BLOOD proBNP-5862*
[**2169-2-14**] 06:50AM BLOOD calTIBC-373 VitB12-1327* Folate-GREATER
TH Ferritn-41 TRF-287

EKG [**2169-2-13**]:
Atrial fibrillation with a rapid ventricular response. Variation
in precordial lead placement as compared to the previous tracing
of [**2169-1-14**]. The inferior ST-T wave changes are slightly more
prominent. Otherwise, no diagnostic interim change.

TWO VIEWS OF THE LEFT TIBIA AND FIBULA [**2169-2-13**]: Diffuse
demineralization limits [**Month/Day/Year 2742**] of the osseous structures. No
fracture or dislocation is present. The left knee is partially
imaged and demonstrates mild-to-moderate degenerative changes
within the medial and lateral compartments. No focal lytic or
sclerotic osseous abnormality is seen. There are no radiopaque
foreign bodies. No focal lytic or sclerotic osseous
abnormalities are present.
.
PELVIS PLAIN FILMS [**2169-2-13**]:
Limited [**Month/Day/Year 2742**]. Chronic fractures of the left superior and
inferior pubic rami. No definite new fractures seen. If there is
continued clinical concern for a pelvic fracture, a CT of the
pelvis can be obtained for further [**Month/Day/Year 2742**].
.
CT C-SPINE [**2169-2-13**]: preliminary read shows no fracture or
subluxation of the cervical spine
.
CT HEAD W/O CONTRAST [**2169-2-13**]: preliminary read shows no acute
intracranial pathology, chronic small vessel ischemia and
atrophy stable. Sinus mucosal thickening new compared with
prior, correlate for sinusitis
.
CXR [**2169-2-13**]: No acute traumatic injury identified. Enlargement
of the hila likely reflective of underlying pulmonary arterial
hypertension. Hiatal hernia with adjacent atelectasis.
.


Brief Hospital Course:
Medicine Floor Course:
Ms. [**Known lastname 2749**] is a [**Age over 90 **]yo [**Age over 90 595**]-speaking female with severe dCHF,
HTN, HLD, neuropathy, gait abnormalities who presents 3 days
after likely mechanical fall without evidence of significant
trauma.

# RESPIRATORY FAILURE:  She developed hypoxia to the low 80s on
3LNC on HD3 with significant resipiratory distress and
tachypnea. CXR showed mild fluid overload.  She was given
albuterol and ipratropium nebulizers and IV lasix with
rebounding of her sats to the upper 90s on 5LNC. She was
agitated and refused to wear an oxygen mask or complete her neb
treatments.  She calmed with IV morphine which likewise lessened
her tachypnea.  She again decompensated with respiratory
distress that evening and was subsequently transferred to the
ICU for further care. The etiology was felt likely combination
of pneumonia plus flash pulmonary edema in the setting of
elevated HR in DHF, also possible aspiration in the setting of
AMS. Pt was intubated and sedated. She was started on Meropenam
and Linezolid for a 10d abx coverage and underwent significant
diuresis with lasix gtt. She became afebrile, leukocytosis
resolved and resp secretions decreased. There were ongoing
discussions with palliative care regarding goals of care and
eventually family decided to extubate without reintubation. Soon
after, patient's oxygenation deteriorated on NC and face mask
and goals of care were shifted towards comfort measures only.
Non essential medications were discontinued and she was put on a
morphine drip. She passed away secondary to hypoxemic
respiratory failure on [**2169-3-2**] at 1:15AM with her daughter at her
bedside.
.
# S/P FALL:  She is a poor historian but states that she did not
lose consciousness or suffer any prodromal syncopal or
presyncopal symptoms.  She sustained no major trauma from her
fall aside from right eye echymoses, and CT of the head and
cervical spine revealed no fractures or bleeds.  She was
admitted for a syncope workup.  Her EKG and cardiac enzymes
ruled out MI.  She had no abnormalities on telemetry.  She was
mentating normally on admission.  She did not start new
medications recently.  She was not orthostatic.  Her daughter
relates a progressive functional decline over the last year
since being intubated in [**2169**] for MRSA pneumonia.  She
had fallen a number of times since.  Mechanical fall was
suspected given her history of lower-half parkinsonism, previous
cerebellar strokes, severe arthritis, unstable gait, and
neuropathy.  Her family had previously decline rehab admission
and had chosen to keep her home with 24 hour care.

# ATRIAL FIBRILLATION:  she has been rate controlled with
diltiazem and metoprolol, which were continued on admission.
These were continued on admission but were intermittently held
due to hypotension. She is not on coumadin given her repeated
falls.  Her rates ranged from the 90s to low 100s, but climbed
to the 110s-120s at the time of her respiratory distress.
Metoprolol was continued during ICU stay at 12.5mg TID, dilt was
held.

# SEIZURE DISORDER:  She has been on phenytoin since her CVA
about 10 years ago which was accompanied by severe seizures.
Phenytoin was continued until goals of care shifted.

#) Altered mental status / agitation - differential includes
hypoxia, infection, MI, PE, antibiotic side effect, delirium.
Pt apparently had normal MS when she presented.  MS appears to
be altered in the setting of hypoxia and respiratory distress.
Infection is also a possibility with known UTI and question of
PNA in the setting of worsened respiratory status.  MI was
considered as possibility as pt complained of chest pain,
although she has had negative CE x 2 since admission.  Pt was
started on cipro for UTI, which is known to cause AMS in elderly
patients. Pt was subsequently intubated and therefore it was
difficult to assess her status, however she alternated between
more agitated and more lethargic. She was started on seroquel
25mg [**Hospital1 **] with some improvement of agitation. As goals of care
shifted, she was put on a morphine drip and agitation resolved.

#) Hypernatremia: Pt developed hypernatremia to 150 in setting
of lasix gtt with inability to take PO. Pt was started on free
water flushes with TF with resolution of hypernatremia.

#) Hypotension: Pt became hypotensive in setting of intubation
and sedation. She was started on neo for pressure support given
tachycardia from a.fib. This was then transitioned to levophed
to improve peripheral perfusion. With decreasing sedation and
decreasing diuresis patient was able to be weaned off pressure
support.

Medications on Admission:
1. diltiazem HCl 240 mg Capsule, Sustained Release daily
2. metoprolol succinate 150 mg daily
3. phenytoin sodium extended 300 mg daily
4. aspirin 325 mg daily
5. ursodiol 300 mg [**Hospital1 **]
6. polyethylene glycol 17grams daily prn constipation
7. senna 8.6 mg [**Hospital1 **] as needed for constipation.
8. docusate sodium 100 mg [**Hospital1 **]
9. torsemide 100 mg Tablet [**Hospital1 **]
10. potassium chloride 20 mEq daily

Discharge Medications:
None.

Discharge Disposition:
Expired

Discharge Diagnosis:
Congestive Heart Failure
Pneumonia


Discharge Condition:
Deceased.


Discharge Instructions:
None.

Followup Instructions:
None.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2764**]

Completed by:[**2169-3-2**]
{'Atrial fibrillation,Pain in joint, pelvic region and thigh,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary tract infection, site not specified,Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Delirium due to conditions classified elsewhere,Abnormality of gait,Black eye, not otherwise specified,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: Ms. [**Known lastname 2749**] is a [**Age over 90 **]yoF with severe diastolic HF NYHA class IV
with multiple exacerbations in past year, HTN, HLD, Afib, and
gait abnormality related to ?DM who presented from home on [**2-13**]
after sustaining a fall 3 day before. Her fall was unwitnessed,
but was thought to be mechanical, as pt tripped while getting
out of bed to the commode.  L hip pain developed over the next
few days, and her family brought her to the ED.  CT scans of the
cervical spine and head were negative for fracture or bleed. A
plain film of the hip showed chronic fractures of the left
superior and inferior pubic rami but no new fractures.  UA was
concerning for UTI, she was started on macrobid.  She was
subsequently transferred to the floor.
.
On transfer to the floor, her VS were 98.2 128/70 98 18 98/4L.
She was without acute complaints initially.  Her antibiotics
were broadened to linezolid and cipro on [**2-15**].  On the evening
of [**2-15**], she triggered on the floor for desaturation to 88% on
2-3L; came up to 94-95% with 5L O2.  At baseline, she is in the
low 90s on 2-3L at home.  She got lasix 60 IV x1 (takes
torsemide 100 [**Hospital1 **] at home, but has been off since presentation
due to hypotension), mucomyst, morphine 0.5, and nebs. Repeat
lasix 40mg IV x1.  ABG 7.51/45/51/37. HR was noted to be in the
120-130s (home B-blockers also stopped secondary to
hypotension), got lopressor 5mg IV x 2 with little effect.
Attempted to put her on face mask for mouth breathing, but
patient kept ripping it off.  Pt was also complaining of chest
pain, and was felt to have altered mental status and increased
agitation.  Pt was trasferred to the MICU for further
management.

MEDICAL HISTORY: - Chronic diastolic heart failure, last EF 65% ([**7-/2168**])
- Hypertension
- Dyslipidemia
- Atrial fibrillation (not anticoagulated due to fall risk)
- Microvascular disease
- Extensive basal ganglia disease
- Gait disorder
- Advanced degenerative joint disease
- Meniere's disease
- Hard of hearing

MEDICATION ON ADMISSION: 1. diltiazem HCl 240 mg Capsule, Sustained Release daily
2. metoprolol succinate 150 mg daily
3. phenytoin sodium extended 300 mg daily
4. aspirin 325 mg daily
5. ursodiol 300 mg [**Hospital1 **]
6. polyethylene glycol 17grams daily prn constipation
7. senna 8.6 mg [**Hospital1 **] as needed for constipation.
8. docusate sodium 100 mg [**Hospital1 **]
9. torsemide 100 mg Tablet [**Hospital1 **]
10. potassium chloride 20 mEq daily

ALLERGIES: Iodine-Iodine Containing / Ampicillin / Phenergan Plain /
Zaroxolyn / Ambien

PHYSICAL EXAM: Admission Physical Exam:
VS - Temp 98.2F, BP128/70 , HR98 , R18 , O2-sat98 % 4LNC dry
weight 60.4 kg
GENERAL - fatigued appearing elderly female in NAD
HEENT - bruising around right orbit with swelling, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, no thyromegaly, JVD to 8cm
LUNGS - bibasilar crackles appreciated
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials,
DPs). Pain on palpation of the feet bilaterally.
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, alert, oriented to person and place. Poor
compliance with neurologic exam, though CN were intact
bilaterally. Strength 5/5 in all extremities. Normal sensation
to light touch in all extremities. Patient declined getting out
of bed for gait assessment and orthostatic vital signs.

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient lives at home by herself at subsidized senior housing in
[**Location (un) **] with assistance from family. She has a 24 hour care
worker that watches her 5 days a week. Her daughter watches her
the other 2 days each week. Her Grandson [**Name (NI) 382**] is an interpreter
at [**Hospital1 18**] and is very active in her care. Granddaughter is ?also
HCP. Aids help her with cleaning and shopping. No smoking or
drinking. 

### Response:
{'Atrial fibrillation,Pain in joint, pelvic region and thigh,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary tract infection, site not specified,Acute and chronic respiratory failure,Acute on chronic diastolic heart failure,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Delirium due to conditions classified elsewhere,Abnormality of gait,Black eye, not otherwise specified,Syncope and collapse,Fall from other slipping, tripping, or stumbling,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}
