Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: history of present illness: this is a 42-year-old hispanic male with a past medical history of hypertension, not currently on treatment who presented to the clinic with increasing shortness of breath, orthopnea and lower extremity edema for 4-5 days. he notes a history of sleeping with 2-3 pillows for the recent past. he has never had symptoms of orthopnea until this past week. he has noticed a 10 lb weight gain over the past month and lower extremity edema over the past 4-5 days. he denies fevers, chills, cough, nausea or vomiting. he had a headache several days ago that was not severe and responded to nsaids. he denies paroxysmal episodes of sweating or palpitations. he denies urinary symptoms or changes in urine color. he denies cocaine or crack use. he presented to the clinic with his symptoms and was found to have a systolic blood pressure of 260. he was referred to the emergency room. in the emergency room he was felt to be in biventricular heart failure with evidence of end organ damage. he was given 20 mg of iv lasix and diuresed 1.5 liters. he was started on iv nitroglycerin and then iv nitroprusside and admitted to the ccu for further management. past medical history: hypertension diagnosed approximately 5 years ago, initially treated with accupril but self discontinued medications about four years ago. has not seen a doctor in years. medications: none. allergies: no known drug allergies. social history: the patient is an electrician who lives in with his girlfriend, and their two children, ages 14 and 5. he denies tobacco use ever. he drinks at least a six pack on the weekends and denies drug use. he is originally from . family history: his mother and father both have essential hypertension. his father has diabetes mellitus. he has a brother who died of an mi in his late 30's. physical examination: this is a well appearing man in no acute distress with a blood pressure of 208/115. it was initially 260/160 in clinic. heart rate is 108, respiratory rate 22 and oxygen saturation 98% on two liters nasal cannula. his heent exam reveals moist mucus membranes. his fundi reveal no papilledema but bilateral hemorrhages with moderate arteriosclerosis. neck is supple with no bruits but he has a jvp of about 10 cm. his lungs are clear to auscultation with no wheezes or rales. he has mildly decreased breath sounds at the bases bilaterally. his heart is tachycardic with a normal s1 and s2. he also has s3 and s4 gallops. there are no murmurs. his abdomen is soft, nontender, non distended and with good bowel sounds. he has no renal bruits. his extremities have 2+ pitting edema to the thigh. he has 2+ dorsalis pedis and radial pulses bilaterally. his neurological exam is non focal. he is awake and oriented times three with intact cranial nerves and v/v strength bilaterally. he has no sensory deficits. laboratory data: revealed a white count of 7.5 with a normal differential. hematocrit was 39. platelet count 317,000. coagulation profile was within normal limits. his chem 7 revealed sodium of 140, potassium 3.3, chloride 104, co2 21, bun 29 and creatinine 2.6. glucose 137. we have no records of earlier creatinine. his lfts were within normal limits, namely his ast was 24, alt 30, total bilirubin 0.7 and alkaline phosphatase 90. his ck was 182 with an mb of 5 and a negative troponin of less than .3. his amylase was 72, lipase 15. his calcium, magnesium and phosphorus were within normal limits. his albumin was 3.6. his tsh was 1.2. urinalysis revealed moderate blood and greater than 300 protein. he had 0-2 red, 0-1 white and 0-2 epi with rare bacteria. an ekg revealed sinus tachycardia at 115 beats per minute with a normal axis and normal intervals. he demonstrated a left atrial abnormality as well as a left ventricular hypertrophy with strain pattern. chest x-ray showed questionable cardiomegaly with mild chf. he had some bilateral pleural effusions and evidence of pulmonary edema at the bases. hospital course: mr. was admitted and placed on a nipride drip and slowly changed to po labetalol. his systolic blood pressure was initially dropped to the 160-180 range and then 140-160 on the second hospital day. initial dose of lasix that he received in the emergency room led to a diuresis of 4 liters. his dyspnea also resolved. an echocardiogram was done to evaluate his cardiac function. it revealed an ef of 30% with bilateral atrial dilatation and moderate symmetric lvh. his tr gradient was 33 mmhg. he had mild lv dilatation and moderate global lv hypokinesis. he also had right ventricular hypertrophy with moderate global right ventricular hypokinesis. he had 1+ mr and 1+ tr. he had mild pulmonary hypertension. given his presentation and family history, it was felt that he was most likely suffering from essential hypertension that was poorly controlled. however, as he was a relatively young man, a work-up for secondary causes of hypertension was performed. his urine was bland with no rbc cast to suggest glomerulonephritis. an mri/mra of his abdomen was also performed which showed no adrenal mass but did reveal a tight proximal right renal artery high grade stenosis. a renal ultrasound was done to evaluate for resistant indices, as well as renal atrophy. his ultrasound revealed no stones and no hydronephrosis but bilateral small kidneys with a right measuring 9 cm and a left measuring 9.3 cm. both renal arteries demonstrated indices of 0.5 with slow systolic upstroke suggestive of bilateral renal artery stenosis. other tests that were performed included a plasma aldosterone that was within normal limits as well as a 24 hour urine collection to look for vma and other signs of pheochromocytoma. these were all negative. he had a normal tsh. he did mention alcohol use, but it was not felt that this was significant enough to be causing his hypertension, although he was advised that excessive alcohol use could exacerbate hypertension. his creatinine clearance was about 40 and his creatinine remained between 2.5 and 3 during his entire stay. a renal consultation was obtained to see if stenting of his right renal artery stenosis would be of any benefit with regards to preserving renal function or in terms of blood pressure control. the renal team determined that it was possible that a stent could allow him to have a few more years off of dialysis, especially given concerns for non compliance and poor follow-up in this patient. thus, he was hydrated and given mucomyst and then underwent catheterization which revealed a 99% proximal right renal artery stenosis status post stent with distal protection with a 0% residual stenosis and no measurable gradient after and no evidence of embolism. he had a completely patent left renal artery. his groin was closed with angiocele and there were no groin complications during his stay. it became clear during his admission that finding appropriate medicine that he would be willing to take and that would be within his economic reach would be slightly difficult given that he has to pay for his own prescription meds. his hypertension was eventually well controlled on atenolol 150 mg q day and nifedipine 60 mg q day. his blood pressures by the time of discharge were running in the 120/70 range. his creatinine remained stable after the procedure and on discharge was 2.6. he was discharged home to follow-up with dr. who will become his primary care physician on or monday, to have a creatinine checked and a blood pressure check. he will also need to follow-up with nephrology clinic in weeks. with regards to his heart, given his history of hypertension and positive family history, an outpatient stress test is recommended in the near future. a cholesterol panel was checked while he was within the hospital and was within normal limits. condition on discharge: improved. discharge status: to home to follow-up with dr. in days and nephrology clinic in weeks. he will also need to follow-up with dr. in weeks with regards to his renal stent. discharge diagnosis: 1. hypertension complicated by chronic renal insufficiency. 2. right renal artery stenosis status post stent placement. discharge medications: aspirin 325 mg po q day, atenolol 150 mg po q day, nifedipine 60 mg po q day, plavix 75 mg po q day times 30 days. , m.d. dictated by: medquist36 d: 19:27 t: 15:27 job#: procedure: angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) arteriography of renal arteries diagnoses: atherosclerosis of renal artery retinal hemorrhage hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage v or end stage renal disease 

Answer: The patient is high likely exposed to