CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 83 year old male
transferred from [**Hospital3 23439**] Hospital in [**Location (un) 8973**] with a
past medical history of diabetes mellitus, chronic renal
insufficiency with baseline of 2.1 creatinine and
hypertension who presented with chest pain and shortness of
breath and ruled in for non-Q wave myocardial infarction with
troponin of 14.5 at an outside hospital.  There he was found
to be in congestive heart failure and diuresed with a
subsequent bump in his creatinine from 2.1 baseline to 2.6.
At the outside hospital an echocardiogram showed severe
aortic stenosis with valve area of 0.5 cm squared and an
ejection fraction of 35%.

MEDICAL HISTORY: No prior cardiac history.  Diabetes
mellitus for 14 years.  Chronic renal insufficiency, baseline
creatinine 2.1.  Stroke ten years ago with a question of a
right facial droop, now on Coumadin.  Echocardiogram at [**Hospital3 38921**] Hospital, [**Location (un) 8973**], showing ejection fraction of
35%, severe atrial fibrillation, hypertension,
hypercholesterolemia, cataract surgery, tonsillectomy,
appendectomy.

MEDICATION ON ADMISSION: (At outside hospital/admission
here)  Aspirin 81 mg p.o. q.d.; Glucotrol 20 mg p.o. q.d.;
Prevacid; Lasix 40 mg intravenously b.i.d.; Lopressor 12.5 mg
b.i.d.; Mucomyst 600 mg p.o. b.i.d.; Heparin drip;
Nitroglycerin drip.  The patient took Coumadin at home 5 mg
q.d. and Nifedipine 60 mg q.d. at home.

ALLERGIES: Sulfa ? reaction; statins with myopathy.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with diabetes in her 70s.

SOCIAL HISTORY: Lives with daughter in [**Location (un) 8973**], quit
tobacco in [**2070**] and smoked [**2-15**] pack per day for 40 years,
worked as a custodian, no alcohol, no drugs.
Subendocardial infarction, initial episode of care,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter
Subendo infarct, initial,Aortic valve disorder,Crnry athrscl natve vssl,Ocl crtd art wo infrct,CHF NOS,Atrial fibrillation,Acute kidney failure NOS,DMII wo cmp nt st uncntr,Renal & ureteral dis NOS
Admission Date: [**2103-1-19**]       Discharge Date: [**2103-1-25**]


Service:  [**Hospital Unit Name 196**]

HISTORY OF PRESENT ILLNESS:  This is an 83 year old male
transferred from [**Hospital3 23439**] Hospital in [**Location (un) 8973**] with a
past medical history of diabetes mellitus, chronic renal
insufficiency with baseline of 2.1 creatinine and
hypertension who presented with chest pain and shortness of
breath and ruled in for non-Q wave myocardial infarction with
troponin of 14.5 at an outside hospital.  There he was found
to be in congestive heart failure and diuresed with a
subsequent bump in his creatinine from 2.1 baseline to 2.6.
At the outside hospital an echocardiogram showed severe
aortic stenosis with valve area of 0.5 cm squared and an
ejection fraction of 35%.

The patient presented with mid sternal chest pain radiating
to both arms, arm heaviness and overwhelming sense of fatigue
and shortness of breath.  It was relieved when he sat upright
and worse when he was lying down.  The patient went to the
Emergency Department and his chest pain was relieved after
one sublingual nitroglycerin.  The patient has had increase
in chest pressure with exertion over the past one and a half
years.  He has also had increased chest pressure, status post
eating which occurs about 15 minutes after a meal.  He has no
fever and chills.  He sleeps on one pillow with no increase,
no paroxysmal nocturnal dyspnea, no coughing, no lightheaded
and no syncope.  He has a history of five to six years of
chronic lower extremity edema.  No abdominal pain after
meals, no melena, no hematochezia, no dysuria, no transient
ischemic attack symptoms.

PAST MEDICAL HISTORY:  No prior cardiac history.  Diabetes
mellitus for 14 years.  Chronic renal insufficiency, baseline
creatinine 2.1.  Stroke ten years ago with a question of a
right facial droop, now on Coumadin.  Echocardiogram at [**Hospital3 38921**] Hospital, [**Location (un) 8973**], showing ejection fraction of
35%, severe atrial fibrillation, hypertension,
hypercholesterolemia, cataract surgery, tonsillectomy,
appendectomy.

MEDICATIONS ON ADMISSION:  (At outside hospital/admission
here)  Aspirin 81 mg p.o. q.d.; Glucotrol 20 mg p.o. q.d.;
Prevacid; Lasix 40 mg intravenously b.i.d.; Lopressor 12.5 mg
b.i.d.; Mucomyst 600 mg p.o. b.i.d.; Heparin drip;
Nitroglycerin drip.  The patient took Coumadin at home 5 mg
q.d. and Nifedipine 60 mg q.d. at home.

ALLERGIES:  Sulfa ? reaction; statins with myopathy.

SOCIAL HISTORY:  Lives with daughter in [**Location (un) 8973**], quit
tobacco in [**2070**] and smoked [**2-15**] pack per day for 40 years,
worked as a custodian, no alcohol, no drugs.

FAMILY HISTORY:  Mother with diabetes in her 70s.

PHYSICAL EXAMINATION:  Examination on admission revealed
temperature 98.4, blood pressure 114/60, pulse 72,
respirations 18, 140 lbs by patient report.  General:  Alert
and oriented in no acute distress.  Head, eyes, ears, nose
and throat, extraocular movements intact, pupils equal, round
and reactive to light, anicteric sclera, mucous membranes
moist.  Neck, no jugulovenous distension, no lymphadenopathy.
 Chest, bibasilar rales.  Cardiac, regular rate and rhythm,
S1 and S2, harsh III/VI systolic ejection murmur, loudest at
apex, radiating to carotids and to femoral vessels.  Abdomen,
nontender, nondistended, normoactive, no organomegaly.
Rectal, large prostate guaiac negative stool.  Extremities,
no cyanosis, clubbing or edema.  Vascular, bilateral femoral
bruits, likely radiated from heart.  Bilateral carotid
bruits, questionably radiating from heart as well.  2+
dorsalis pedis pulses bilaterally.  Neurologic, cranial
nerves II through XII intact.  Strength, [**6-18**] in upper and
lower extremities.  Left arm with slight intention tremor.
Sensory grossly intact.  Patellar reflexes equal bilaterally.
 Babinski downgoing bilaterally.

LABORATORY DATA:  Laboratory studies at the outside hospital
on admission on [**1-19**], white blood cell count 10,
hematocrit 37.8, platelets 145, LDL in 200s.  Sodium 136,
potassium 4.5, chloride 96, bicarbonate 30, BUN 51,
creatinine 2.6, platelets 202, calcium 8.5 and INR 1.8.
Electrocardiogram, normal sinus rhythm, 70, left axis
deviation, positive left atrial abnormality, positive left
ventricular hypertrophy, positive left ventricular strain
pattern in V4 through V6 and one in AVL.

HOSPITAL COURSE:  This is an 83 year old male without
significant past cardiac history with a history of
hypercholesterolemia, diabetes mellitus, and hypertension who
was transferred from an outside hospital after ruling in for
non-Q wave myocardial infarction, congestive heart failure
and found to have critical aortic stenosis by echocardiogram.
The patient was also found to have increase in his creatinine
from 2.1 to 2.6 after diuresis of his congestive heart
failure.  On presentation he was asymptomatic with
Nitroglycerin drip and status post diuresis.

1.  Cardiac - A.  Coronary artery disease, the patient with
increasing exertional chest pressure over the past few months
with more recent increased angina when lying down flat,
relieved when sitting upright.  This is likely due to
elements of congestive heart failure when lying flat.  He
ruled in for non-Q wave myocardial infarction by positive
troponins at outside hospital.  He likely has both coronary
artery disease and subendocardial ischemia with his critical
aortic stenosis.  On admission here he was continued on his
heparin drip, weaned off of his Nitroglycerin drip because of
his critical aortic stenosis and continued on his beta
blocker and Aspirin.

Cardiac catheterization was done after his renal function
showed some improvement.  This showed:  Three vessel cardiac
disease with calcified left anterior descending and moderate
diffuse disease throughout with stenosis of 60% in the mid
segment.  The dominant circumflex had 50% proximal disease
and 80% distal disease.  An obtuse marginal had a proximal
90% stenosis.  The nondominant right coronary artery also had
a stenosis of 80% at its mid segment.

Because of his three vessel disease, this patient was thought
to be a candidate for coronary artery bypass graft.  The
patient was awaiting coronary artery bypass graft and had
multiple episodes of chest pain during this time.  This chest
pain was relieved on occasion by merely sitting the patient
upright.  Other times it required one to two sublingual
nitroglycerins administered judiciously to try to prevent too
much preload reduction with his critical aortic stenosis.  On
occasion this chest pain was associated with flash pulmonary
edema and desaturations to 85% which was relieved by
sublingual nitroglycerin and Lasix.

B.  Pump, this is a patient with critical aortic stenosis
seen by cardiac catheterization and echocardiogram with
increasing angina, and dyspnea.  He has no history of
syncope.

Cardiac catheterization showed hemodynamics with normal
right-sided filling pressures and mildly elevated left-sided
filling pressures with a mean gradient of 35.5 mg of mercury
across the aortic valve and a calculated valve area of 0.79
cm squared.  The cardiac index was mildly reduced at 2.3.

The patient had echocardiogram as well this admission which
showed ejection fraction of 40%.  The severe aortic stenosis
was seen with symmetric left ventricular hypertrophy and
regional dysfunction of his inferolateral and inferior walls
with hypo and akinesis in this region consistent with
coronary artery disease.  He also had mild to moderate mitral
regurgitation and moderate pulmonary artery hypertension by
this study.

The patient was continued on his Metoprolol 25 mg p.o. b.i.d.
and cautious use of Nitroglycerin was used during his
episodes of flash pulmonary edema.

CEP, the patient was in normal sinus rhythm throughout this
hospitalization with evidence of left ventricular strain on
his electrocardiogram with no significant event on telemetry.

The patient has a history of hypertension and has blood
pressure ranged from 120 to 160 systolic during this
hospitalization.

2.  Carotid artery disease - The patient was thought to be a
candidate for coronary artery bypass graft and aortic valve
repair.  Prior to his surgery he did receive a carotid artery
duplex evaluation which showed 80 to 99% stenosis of the
right internal carotid artery and occlusion of the left side.
He was then given an magnetic resonance imaging scan,
magnetic resonance angiography of his head and neck which
confirmed these ultrasound studies.  It did show a patent
circle of [**Location (un) 431**] and flow in the vertebral arteries.  The
patient was thought to benefit most from right coronary
artery stenting prior to his coronary artery bypass graft and
aortic valve repair surgery.  At the time of this dictation
he will be undergoing this procedure today.  He had no signs
of acute stroke by his magnetic resonance imaging scan.

3.  Renal - The patient had acute and chronic renal failure,
status post diuresis for his congestive heart failure on
admission.

The patient's creatinine fluctuated between 2.1 and 2.6
during this hospitalization with an increase 48 hours after
cardiac catheterization and slight increases after his
diuresis in the setting of his flash pulmonary edema.
Overall, however, it has ranged in the 2.4 to 2.5 range with
good urine output.

4.  Hematology - The patient had been anticoagulated for his
history of stroke.  He was continued on his heparin GGT
during this admission for his acute coronary syndrome as well
as his cardiovascular disease.  His Coumadin was held.  His
platelets remained stable in the low 100s on heparin
throughout this stay.

5.  Diabetes mellitus - His blood sugars ranged from 170 to
250 during his stay on the floor on a regular insulin sliding
scale.  He was kept on the sliding scale and his Glucotrol
was discontinued because of his multiple catheterizations and
during this week.

6.  Hypercholesterolemia - The patient could not tolerate
statins and develops myopathy with these.  He was continued
on a low cholesterol diet.

DISPOSITION:  The patient will have his carotid stent and go
to the Coronary Care Unit.  He will then be transferred to
the Cardiothoracic Surgery Team for coronary artery bypass
graft and aortic valve repair.

This dictation encompasses the hospital stay from [**1-19**]
to [**2103-1-14**].

MEDICATIONS:
1.  Aspirin 81 mg p.o. q.d.
2.  Protonix 40 mg p.o. q.d.
3.  Metoprolol 25 mg p.o. b.i.d.
4.  Insulin sliding scale
5.  Nitroglycerin 0.3 mg sublingual times one prn



                            [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D.  [**MD Number(1) 2144**]

Dictated By:[**Last Name (NamePattern4) 47047**]
MEDQUIST36

D:  [**2103-1-25**]  15:36
T:  [**2103-1-25**]  16:33
JOB#:  [**Job Number 47048**]


Admission Date:                   Discharge Date:  [**2103-2-2**]


Service:

ADDENDUM
The patient was kept for two additional days, and was
discharged on [**2103-2-2**] in order to observe the patient and
follow the patient's creatinine.  On [**2103-2-2**], the patient's
creatinine was decreased appropriately from 3.2 to 3.1, and
it was agreed upon by the primary team to discharge the
patient in light of the patient's plateauing creatinine,
which was thought to be secondary to diuresis by using
furosemide as well as hypotension intraoperatively.  The
patient is to follow up with the [**Hospital 10701**] Clinic as well as
the primary care physician and Dr. [**Last Name (STitle) **] in four weeks.

DISCHARGE MEDICATIONS:
1.  Norvasc 2.5 mg by mouth once daily
2.  Ciprofloxacin 500 mg by mouth once daily for seven days
3.  Glipizide 10 mg by mouth once daily
4.  Plavix 75 mg by mouth once daily
5.  Aspirin 325 mg by mouth once daily
6.  Zantac 150 mg by mouth twice a day
7.  Colace 100 mg by mouth twice a day
8.  Lopressor 12.5 mg by mouth twice a day
9.  Tamsulosin 0.4 mg by mouth daily at bedtime
10. Percocet one to two tablets by mouth every four to six
hours as needed for pain




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 17480**]
MEDQUIST36

D:  [**2103-2-4**]  18:06
T:  [**2103-2-5**]  01:02
JOB#:  [**Job Number **]


Admission Date:  [**2103-1-19**]       Discharge Date:  [**2103-2-2**]


Service:  CARDIOTHORACIC

HISTORY OF PRESENT ILLNESS:  The patient is an 83 year-old
male transferred from [**Hospital6 14576**] with a past
medical history of diabetes mellitus, CRI, hypertension
presenting with shortness of breath, chest pain and ruled in
for a non Q wave myocardial infarction with troponin highs of
14.5.  The patient was found to be in congestive heart
failure, was diuresed, creatinine increased from 2.1 to 2.6.
Echocardiogram showed severe aortic stenosis, 0.5 cm squared
and an ejection fraction of 35%.  The patient presented with
mid sternal chest pain radiating to both arms, arm heaviness,
and fatigue, question short of breath.  Relieved when he sat
upright and worse when lying.  The patient went to the
Emergency Department and chest pain was relieved after one
nitro and has been chest pain free since.  He has had
increased chest pain with exertion for the past one and a
half years.  Also increased chest pain with eating, fifteen
minutes after eating.  No fevers or chills.  The patient
sleeps on one pillow.  No paroxysmal nocturnal dyspnea, no
cough, no lightheadedness, no syncope.  History of five or
six years of chronic lower extremity edema.  No abdominal
pain after meals. No melena.  No hematochezia, polyuria.  No
transient ischemic attack symptoms.

PHYSICAL EXAMINATION:  The patient's vital signs are stable.
Neck no JVD. No lymphadenopathy.  Chest bibasilar rales.
Cardiovascular regular rate and rhythm.  S1 and S2.  3 out of
6 systolic ejection murmur loudest at apex, radiates to
carotids.  Abdomen nontender, nondistended.  No organomegaly.
Rectal large prostate, guaiac negative stool.  Extremities no
clubbing, cyanosis or edema.  Vascular bilateral femoral
bruits, bilateral carotid bruit, question radiating from
aortic stenosis.  2+ dorsalis pedis pulses.  Neurological
cranial nerves II through XII intact.  Strength 5 out of 5
upper extremities and lower extremities.  Left arm slight
intention tremor.  Sensory grossly intact.  Patella reflexes
equal bilaterally.  Babinski downward.

LABORATORY:  Hematocrit 37.8, creatinine 2.6, calcium 8.5,
INR 1.8.  Electrocardiogram normal sinus rhythm at 70, left
axis deviation down sloping ST depressions in 1 through AVL,
V4 through V6 versus left ventricular strain.

HOSPITAL COURSE:  The patient is admitted to the [**Hospital Unit Name 196**] Service
on [**2103-1-19**] for complaints of chest pain at which time the
patient ruled in and was transferred to [**Hospital1 190**] from [**Hospital3 **].  The patient was started on
a heparin drip, nitro drip and sublingual nitroglycerin prn,
beta blocker and aspirin.  Cardiac catheterization was also
recommended.  The patient's kidney function was also assessed
as acute on chronic renal failure, which at that time was
attributed to prerenal failure.  Subsequent cardiac
catheterization showed left main coronary artery with no
significant obstructive disease, left anterior descending
coronary artery with 60% stenosis in the mid portion, left
circumflex 70% proximal, 90% stenosis at the obtuse marginal
one, 90% distal obstruction and right coronary artery with
small nondominant 70% mid vessel stenosis.  Aortic valve
gradient was 15 mmHg.  At that time it was thought that
because of the patient's three vessel disease that he should
proceed to Cardiothoracic Surgery for coronary artery bypass
graft.  In addition, the patient was worked up for his
carotid disease and the vascular laboratory reported carotid
stenosis of 80 to 99% of the right coronary artery and no
flow detected in the left internal carotid.

A renal consult was obtained for the patient's acute
on chronic renal failure at which time the following
recommendations were made, to hold off on the patient's
diuretics, review urinary sediment and to hold on the
patient's ace inhibitor and to avoid nephrotoxins.  It is
believed that the patient's acute renal insufficiency was due
to redo contrast nephrotoxicity.  The chronic renal disease
was secondary to diabetes.  The patient had no evidence of
atheroemboli.  On hospital day five the patient was noted to
have flash pulmonary edema.  The Stroke Service was consulted
in order to place a stent in the right internal carotid
artery before the patient's aortic valve replacement and
coronary artery bypass graft.  The findings on duplex
ultrasound were confirmed by MRA.  The patient was found to
have severe right coronary artery stenosis.  On [**2103-1-25**] the patient had a 30 mm carotid stent placed in the
right ICA.  The patient was seen by cardiac surgery at which
time possible risks and complications were explained to him
and consent was signed.

The patient was taken to the Operating Room on [**2103-1-26**] at
which time coronary artery bypass graft times three was
performed.  The patient's left internal mammary coronary
artery was taken to the left anterior descending coronary
artery, saphenous vein graft to the posterior descending
coronary artery, saphenous vein graft to the obtuse marginal.
The patient was cross clamped for 115 minutes and
cardiopulmonary bypass times 147 minutes.  In addition, he an
aortic valve replacement was performed.  A #19 mm CE Bovine
pericardial valve was placed.  Postoperative day number one
the patient did well on CPAP and pressure support of 10 to
15.  The patient's blood gases were normal at that time and
on postoperative day number two the patient continue to
resolve without neurological deficits.  He was continued on
his aspirin and Plavix for patency of the carotid stent.  On
postoperative day number three the patient was felt to be
stable and was subsequently transferred to the cardiac
surgical floor.

On the floor the patient's Foley was discontinued, but had to
be replaced secondary to a 12 hour lack of urination.  Post
void residual was 700.  The patient's creatinine continued to
creep up to approximately 3.1.  The patient's blood pressure
also elevated and renal recommended Norvasc 2.5 mg po q day.
The patient also received 1 unit of packed red blood cells
for a hematocrit of 26, which was on repeat hematocrit 30.7.
On postop day seven the patient's AV wires were taken out and
the patient was found to be stable for rehab.  Urology had
seen the patient and has recommended starting the patient on
Flomax .4 for the patient's urinary retention.  The patient
is to have voiding trial in one week and is leaving with a
urinary leg bag.  The patient is to follow up with nephrology
and with the Neurological Stroke service.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To rehab.

DISCHARGE DIAGNOSES:
Status post right internal carotid artery stent and status
post coronary artery bypass graft with aortic valve
replacement.

DISCHARGE MEDICATIONS:  Norvasc 2.5 mg po q day,
Ciprofloxacin 500 mg po q 24 hours, Glipizide 10 mg po q day,
Plavix 75 mg po q day, aspirin 325 mg po q day, Zantac 150 mg
po q day, Colace 100 mg po b.i.d. and Lopressor 25 mg po
b.i.d.

FOLLOW UP PLANS:  The patient is to follow up with the
Neurology Stroke Service in two weeks.  The patient is to
follow up with Dr. [**Last Name (STitle) **] in four weeks and should follow up
with the Nephrology Service in two weeks as well.






                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 8455**]
MEDQUIST36

D:  [**2103-2-2**]  10:36
T:  [**2103-2-2**]  10:44
JOB#:  [**Job Number 19515**]
{'Subendocardial infarction, initial episode of care,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter'}


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: 

PRESENT ILLNESS: This is an 83 year old male
transferred from [**Hospital3 23439**] Hospital in [**Location (un) 8973**] with a
past medical history of diabetes mellitus, chronic renal
insufficiency with baseline of 2.1 creatinine and
hypertension who presented with chest pain and shortness of
breath and ruled in for non-Q wave myocardial infarction with
troponin of 14.5 at an outside hospital.  There he was found
to be in congestive heart failure and diuresed with a
subsequent bump in his creatinine from 2.1 baseline to 2.6.
At the outside hospital an echocardiogram showed severe
aortic stenosis with valve area of 0.5 cm squared and an
ejection fraction of 35%.

MEDICAL HISTORY: No prior cardiac history.  Diabetes
mellitus for 14 years.  Chronic renal insufficiency, baseline
creatinine 2.1.  Stroke ten years ago with a question of a
right facial droop, now on Coumadin.  Echocardiogram at [**Hospital3 38921**] Hospital, [**Location (un) 8973**], showing ejection fraction of
35%, severe atrial fibrillation, hypertension,
hypercholesterolemia, cataract surgery, tonsillectomy,
appendectomy.

MEDICATION ON ADMISSION: (At outside hospital/admission
here)  Aspirin 81 mg p.o. q.d.; Glucotrol 20 mg p.o. q.d.;
Prevacid; Lasix 40 mg intravenously b.i.d.; Lopressor 12.5 mg
b.i.d.; Mucomyst 600 mg p.o. b.i.d.; Heparin drip;
Nitroglycerin drip.  The patient took Coumadin at home 5 mg
q.d. and Nifedipine 60 mg q.d. at home.

ALLERGIES: Sulfa ? reaction; statins with myopathy.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with diabetes in her 70s.

SOCIAL HISTORY: Lives with daughter in [**Location (un) 8973**], quit
tobacco in [**2070**] and smoked [**2-15**] pack per day for 40 years,
worked as a custodian, no alcohol, no drugs. 

### Response:
{'Subendocardial infarction, initial episode of care,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter'}
