system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 50-year-old woman comes to the physician for a follow-up examination. Two weeks ago she was seen for adjustment of her antihypertensive regimen and prescribed lisinopril because of persistently high blood pressure readings. A complete blood count and renal function checked at her last visit were within the normal limits. On questioning, she has had fatigue and frequent headaches over the last month. She has hypertension, type 2 diabetes mellitus, polycystic ovarian disease, and hyperlipidemia. Her mother has hyperthyroidism and hypertension. Current medications include amlodipine and hydrochlorothiazide at maximum doses, lisinopril, metformin, glimepiride, and atorvastatin. She has never smoked and drinks 1–2 glasses of wine with dinner every night. She is 167 cm (5 ft 5 inches) and weighs 81.6 kg (180 lbs); BMI is 30 kg/m2. Her blood pressure is 170/110 mm Hg in both arms, heart rate is 90/min, and respirations are 12/min. Examination shows an obese patient and no other abnormalities. Laboratory studies show:
Hemoglobin 14 g/dL
Leukocyte count 7,800/mm3
Serum
Na+ 139 mEq/L
K+ 3.4 mEq/L
Cl- 100 mEq/L
Creatinine 2.1 mg/dL
Urea nitrogen 29 mg/dL
TSH 3 μU/mL
Urine
Blood negative
Protein negative
Glucose 1+
Which of the following is the most likely diagnosis?"
assistant
Renal artery stenosis
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