A 38-year-old man presents to an outpatient clinic with several nonspecific complaints. The patient relates that for the past 3 to 4 months, he has become easily fatigued and has been unable to concentrate at work. He has also developed poor appetite and pain in his thighs, knees, and legs. He has been generally healthy in the past but has not seen a physician in 6 years. Eight years ago, when he visited an emergency center for the treatment of a laceration on his arm, he was informed that his blood pressure was elevated.
The patient is currently afebrile; his blood pressure is 160/94 mm Hg; pulse is 84 beats/min and regular. He has several areas of skin ecchymosis over his knees and thighs. His white blood cell (WBC) count is 6500, hemoglobin 9 g/dL, hematocrit 5%, blood urea nitrogen 80 mg/dL, serum creatinine 8.5 mg/dL, and serum potassium 5.0 mEq/L. What is the likely diagnosis?…
