A 67-Year-Old Man Comes to the Office Due to Generalized

A 67-year-old man comes to the office due to generalized weakness, easy fatigability, anorexia, and intermittent nausea for the past several months.  He also says that he is "itching and scratching a lot."  Physical examination shows bilateral lower extremity pitting edema and skin excoriations.  Laboratory results show a serum creatinine level of 3.4 mg/dL and a blood urea nitrogen level of 48 mg/dL.  A renal biopsy is performed.  Light microscopy of the tissue sample shows widespread narrowing of the renal arterioles with deposition of homogeneous, glassy material in the vessel walls that stains pink with periodic acid-Schiff (PAS) stain.  This patient most likely has which of the following underlying conditions?

A) Atheroembolic renal disease
B) Diabetes mellitus
C) Malignant hypertension
D) Multiple myeloma
E) Rapidly progressive glomerulonephritis

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