A 68-Year-Old African American Man Is Evaluated for Several Weeks

A 68-year-old African American man is evaluated for several weeks of progressive fatigue.  His other complaints include abdominal discomfort, lower extremity edema, and chronic dry cough.  He has not experienced fever, chills, or weight loss.  He has a history of type 2 diabetes mellitus diagnosed 5 years ago, hypertension, and hyperlipidemia.  Current medications include amlodipine, lisinopril, metformin, glyburide, and rosuvastatin.
His temperature is 37.1 C (98.8 F) , blood pressure is 165/92 mm Hg, pulse is 84/min, and respirations are 16/min.  Examination shows a 2/6 systolic ejection murmur along the left sternal border without radiation and 2+ pretibial edema bilaterally.
Laboratory results are as follows:

Chest X-ray shows mild cardiomegaly and small bilateral pleural effusions.
Which of the following is the most likely diagnosis?

A) Acute interstitial nephritis
B) Diabetic nephropathy
C) Focal segmental glomerulosclerosis
D) Multiple myeloma
E) Sarcoidosis

Correct Answer:

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