A 64-Year-Old Man Comes to the Emergency Department Due to Flank

A 64-year-old man comes to the emergency department due to flank discomfort and red urine.  He has a history of hypertension and type 2 diabetes mellitus.  Three months ago, the patient had an ischemic stroke and now has mild, residual, right-sided weakness.  Serum creatinine is 0.9 mg/dL, and serum lactate dehydrogenase is elevated.  Urine microscopy shows many red blood cells.  The findings of a CT scan of the abdomen with contrast are shown in the image below: Which of the following is the most likely cause of this patient's symptoms?

A) Atrial fibrillation
B) Deep venous thrombosis of the lower extremities
C) Focal segmental glomerulosclerosis
D) Hypersensitivity interstitial nephritis
E) Pulmonary hypertension

Correct Answer:

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