A 64-Year-Old Man Comes to the Office After Learning at the Dentist's

A 64-year-old man comes to the office after learning at the dentist's office that he has elevated blood pressure.  The patient is a combat veteran and has always been "fit as a bull."  He has undergone various minor surgical procedures for wartime injuries.  He reports many years of tobacco and alcohol use but currently uses neither.  On careful questioning, he describes chest pain on exertion.  Blood pressure is 155/90 mm Hg and pulse is 76/min.  Physical examination is significant for decreased pulse amplitude over the right femoral artery and a systolic bruit over the left carotid artery.  Resting ECG is unremarkable, and serum creatinine is 1.1 mg/dL.  Urinalysis is negative for protein.  Treatment for hypertension is initiated with ramipril.  On a follow-up visit 3 weeks later, blood pressure is 142/85 mm Hg but serum creatinine has increased to 2 mg/dL.  This laboratory finding is best explained by an effect of the drug on which of the following structures (as indicated in the image) ?

A) A
B) B
C) C
D) D
E) E

Correct Answer:

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