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: allergies: levofloxacin attending: chief complaint: shortness of breath major surgical or invasive procedure: renal artery stent history of present illness: 73 yo f with htn, cri, s/p left nephrectomy, right ras s/p stenting in , chf, presented with worsening dyspnea. found to be in chf in setting of hypertensive emergency. the renal artery was re-evaluated given high suspicion of restenosis. taken for cath on , which revealed 95% right renal artery instent restenosis. the vessel was stented again. post-stenting, the pt continued to have elevated bp, and worsening renal function. she was thought to have contrast nephropathy. also, she had hct drop noted on of 30 to 23. she was given 2u rbcs with bump in cr to 25. she then began complaining of ruq pain. mri/mra showed large subcapsular hematoma with active bleeding. transferred to ccu for closer monitoring. past medical history: 1. s/p left sided nephrectomy for renal cell ca - no chemo or xrt 2. diabetes mellitus x 20 years -- currently on glyburide and insulin 3. hypertension 4. chronic renal insufficiency - cr 1.5 in 5. bilateral knee replacements 6. reports benign breast lump many years ago. 7. h/o admission for e coli uti w/ ?urosepsis 8. h/o guaiac positive stool - colonoscopy with diverticulosis of sigmoid 9. renal artery stenosis on right - s/p stenting in - doppler in showed normal arterial and venous waveforms and flow 10. clean coronaries on cath social history: lives in ; originally from but has lived here for 35 years. not currently working but used to work in housekeeping. denies any history of smoking, alcohol, or drug use. widow. has 7 children. family history: both parents w/ dm, daughter w/ dm; denies any other known family history. physical exam: vs - t 98.6, bp 168/50, hr 82, rr 22, o2 sat 96% 2l general - comfortable, resting in bed, nad heent - perrl, eomi, op clr, mmm, jvd not appreciated cv - rrr w/ ectopy, nl s1 s2, syst mur at base chest - bibasilar crackles abdomen - nabs, soft, nt/nd, no g/r back - non-tender to palpation ext - l>r lower extremity edema, trace on r, 2+ on l (pt laying on l side) neuro - cn ii-xii intact, strength 5/5 throughout, sensation intact to lt touch pertinent results: h c t - 3 3 . 7 - - > 3 0 . 0 ( 7 / 6 ) - - > 2 3 . 6 ( 7 / 7 ) - - > 2 3 . 3 - - > 2 5 . 9 ( 7 / 8 ) - - > 2 4 . 7 - - >25.3-->28.6()-->27.8-->27.1-->27.5-->29.2()-->28.8() . c r e a t - 2 . 0 - - > 2 . 3 ( 7 / 5 ) - - > 3 . 1 ( 7 / 6 ) - - > 2 . 7 - - > 3 . 5 ( 7 / 7 ) - - > ( 7 / 8 ) - - > 3 . 1 ( 7 / 9 ) - - > 3 . 4 - - > 3 . 8 - - > 4 . 0 ( 7 / 1 0 ) - - > 4 . 1 - - > 4 . 4 ( 7 / 1 1 ) - - > 5 . 3 - - >5.6-->5.7()-->5.6()-->4.7()-->4.4()-->creat-4.7 . probnp-8986 . urine rbc-* wbc->50 bacteri-many yeast-none epi- urine cx >100,000 e. coli . renal cath (): 95% right renal artery in-stent restenosis. successful ptca/stent of right renal artery with a 6.0 x 18mm racer stent . renal mri/mra (): large perinephric hematoma including mass effect on the lateral aspect of the right kidney. active extravasation seen in the course of this exam though not accumulating at a very brisk rate. no abnormality of the visualized right renal artery and the extravasation is quite lateral to any of the extrarenal renal artery branches. . echocardiogram: the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis. mild (1+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve leaflets are mildly thickened. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. . brief hospital course: 73 f with right renal artery stenosis s/p stenting complicated by subcapsular hemorrhage. . ## cvs: -ischemia: known cad. --- pt was initially only given asa 81 mg po as therapy in light of her capsular hemorrhage post-renal atery stenting. she was eventually started back on clopidogrel 75 mg po qd once the bleeding ceased. -pump: chf on presentation likely secondary to hypertensive emergency. pt was volume overloaded while in the ccu; however, became she became short of breath due to volume overload only once. because of her volume overload in the setting of oliguric renal failure, she eventually required dialysis. she underwent two sessions of dialysis, and subsequently responded to well diuresis with furosemide and metolazone. pt was started on daily diuretic therapy since she seemed to consistently develop le edema & basilar crackles on lung exam when not recieving diuretics. -valves: no known dz -rhythm: no electrical abnormalities. monitored on telemetry. . ## renal: pt's initial presentation with hypertensive urgency was attributed to re-stenosis of her renal artery stent. even after ptca & re-stenting of the renal artery the pt's bp remained elevated & her renal failure persisted. her blood pressure was initially treated in the ccu with a nitro drip. then changed to labetalol drip before converting to po labetalol and being transfered to the floor. multiple agents were required to lower the pt's bp. after trying numerous combinations the following meds seemed to control her pressure adequately: labetolol, hydralazine, nifedipine, and clonidine (initially po then patch). since stabilization on these medications, her sbp has remained mostly <140. of note, pt's oral clonidine was tapered during the transition to the clonidine patch; however, she should be monitored for rebound hypertension as the taper has just been completed. post-renal artery cath, the pt's renal function became progressively worse, peaking at a creatinine of 5.7. she became uremic. a tunneled catheter was placed for dialysis, which was performed twice with good effect. after dialysis, her crt began to trend downward, leveling off at 2.7. her acute renal failure was likely multifactorial (hypertensive emergency, dye load, ? constriction from hematoma). her urine output improved after dialysis, though it was still low. because of this and the associated signs of volume overload, we started her on daily diuretic therapy. -pt's potassium was noted to be rising following cath (from 3.3 to 5.1 over two days). has improved to 4.7 on loop diuretic. this needs to be monitored every few days. . ## id: pt was diagnosed with a foley catheter-associated uti and treated with 10-day course of ceftriaxone 1 g iv qd because she has a levofloxacin allergy. the urine culture revealed pan-sensitive e. coli. repeat urine culture revealed no growth. pt's wbc has been rising slightly. on, , wbc=12.9. pt has been afebrile. if wbc continues to rise, she may need a repeat ucx. there was no evidence of lower extremity cellulitis, though there was concern that with her lower extremity swelling that she might develop this if the skin breaks. . ## dm: pt was on nph 7 qam/7 qpm along with riss. since she had been requiring an additional 8units of insulin on top of her nph at 7qam/7qpm, we increased her nph to 14 qam / 7 qpm upon discharge. her glyburide was held given her renal failure. . ## anemia: pt's anemia was attributed to her sub-capsular hematoma & also epo deficiency in the setting of renal failiure. she received multiple units of prbc's to stabilize her hct. overtime, her hct improved, and the sub-capsular hematoma was found to be stable on repeat imaging. she was started on epo per renal's recommendation. hct has stabilized around 30. . ## le edema: during hospitalization, pt was noted to have assymetric lower extremity edema (l>r). there was associated tenderness mild erythema. despite getting dvt prophylaxis, there was still concern that this might be dvt given her prolonged bed-rest. she underwent lower extremity ultra-sound which was negative for dvt. following negative u/s, she was diuresed. the swelling will likely improve with continued daily diuretic therapy. . ## ?depression: the pt's mood seemed depressed. though she denied being depressed, she did admit to feeling hopeless & helpless. she refused to talk to a psychiatrist while in hospital. we started her on zoloft 50mg/day . dr. will be following up on this issue with the pt within one week of discharge. . ## activity: pt worked with physical therapy on a few occasions during hospitalization. she needed assistance ambulating, and they recommended rehab to help improve her physical condition. . ## skin: pt was noted to have multiple small stage 1 ulcers on her bottom that were treated with duo-derm. she will benefit from wound care and improved ambulation. . ## social: pt's family came regularly to see pt. they took an active interest in her care. medications on admission: 1. hydralazine 50 mg po qd 2. hydrochlorothiazide 25 mg po daily 3. metoprolol tartrate 50 mg po tid 4. clopidogrel 75 mg po daily 5. atorvastatin 20 mg po daily 6. glyburide 10 mg po daily 7. aspirin 325 mg po daily 8. benicar 40 qd 9. insulin n 10u qd 10. procrit qwk discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. labetalol 200 mg tablet sig: four (4) tablet po bid (2 times a day): please hold if hr < 60 or sbp <100. 7. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily): please hold if sbp <100. 8. hydralazine 50 mg tablet sig: one (1) tablet po qid (4 times a day): please hold if sbp <100. tablet(s) 9. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 10. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch transdermal once a week: please apply every monday, and change site of patch with each application. if pt experiences, burning at patch site, please remove & discontinue. let dr. know. 11. bumetanide 0.5 mg tablet sig: two (2) tablet po daily (daily). 12. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 13. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. 14. insulin nph human recomb 100 unit/ml cartridge sig: one (1) subcutaneous twice a day: 14units in the am 7units in the pm. 15. zoloft 25 mg tablet sig: two (2) tablet po once a day: watch for signs of suicidality, as this is a new medication for the pt. 16. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: hypertensive urgency renal artery instent restenosis renal subcapuslar hematoma chf acute on chronic renal insufficiency discharge condition: stable discharge instructions: if pt spikes a fever or if wbc is increasingly elevated, check a u/a and urine culture. pt recently treated for a uti. also, watch for signs of cellulitis as pt's legs have been swollen in setting of volume overload. . -please contact or return to the er if the pt develops any of the following symptoms: chest pain, palpitations, shortness of breath, fever, or decreased urine output. followup instructions: -wednesday 4:30pm appointment with dr. at his office at , , , phone: . -appointment scheduled on at 1pm with nephrologist , md. location: of , building medical specialties . please arrange an appointment with your primary care () within 1 wk of discharge from rehab. procedure: venous catheterization, not elsewhere classified hemodialysis angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transfusion of packed cells transfusion of platelets cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia hemorrhage complicating a procedure other complications due to other vascular device, implant, and graft personal history of malignant neoplasm of kidney acquired absence of kidney diastolic heart failure, unspecified knee joint replacement other drugs and medicinal substances causing adverse effects in therapeutic use family history of diabetes mellitus unspecified renovascular hypertension 

Answer: The patient is high likely exposed to