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A 56-year-old man presents with hypertension and peripheral edema. He is otherwise healthy and takes no medications. Family history reveals that his father and a brother have kidney disease. His father was on hemodialysis before his death at age 68 of a stroke. Physical examination reveals BP 174/96 and AV nicking on funduscopic examination. He has a soft S4 gallop. Bilateral flank asses measuring 16 cm in length are palpable. Urinalysis shows 15 to 20 RBC/hpf and trace protein but is otherwise normal; his serum creatinine is 2.4 mg/dL.Which is the most likely long-term complication of his condition?
End-stage renal disease (ESRD) requiring dialysis or transplantation
Malignancy
Ruptured cerebral aneurysm
Biliary obstruction owing to cystic disease of the pancreas
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