A 52-year-old man comes to the emergency department because of a 1-day history of nausea, vomiting, and rightsided
abdominal pain that radiates to his back. He has not had fever or increased urinary frequency. He has a history
of type 2 diabetes mellitus, hyperlipidemia, hypertension, and atrial fibrillation. Current medications are
atorvastatin, glyburide, hydrochlorothiazide, lisinopril, and warfarin. He smoked 1½ packs of cigarettes daily for 35
years until he quit 6 months ago. He has had no recent alcoholic beverage or illicit drug use. He is 188 cm (6 ft 2 in)
tall and weighs 109 kg (240 lb); BMI is 31 kg/m2. Temperature is 36.4°C (97.6°F), pulse is 88/min, respirations are
20/min, and blood pressure is 165/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of
96%. Physical examination discloses right upper quadrant and flank tenderness but no rebound tenderness or
guarding. CT scan of the abdomen with and without contrast shows an enlarged right kidney and wedge-shaped
areas of hypodensity; there is no evidence of nephrolithiasis. Which of the following is the strongest predisposing
risk factor for this patient’s condition?
(A) Atrial fibrillation
(B) Hyperlipidemia
© Hypertension
(D) Past smoking history
(E) Type 2 diabetes mellitus