During a routine physical examination, a 42-year-old female is found to have an elevated blood pressure of 150/100 mmHg. Workup reveals a small left kidney and a normal-sized right kidney. Laboratory examination reveals elevated serum renin levels. Fuher workup reveals that renal vein renin levels are increased on the left but decreased on the right. This patient’s hypeension is most likely the result of

**Core Concept**
The patient's hypertension is likely due to an increase in renin secretion from the affected kidney, which is causing an increase in angiotensin II and aldosterone, leading to vasoconstriction and fluid retention.

**Why the Correct Answer is Right**
The elevated serum renin levels and increased renal vein renin levels on the left kidney suggest that the left kidney is overproducing renin. This excess renin is likely due to a renin-secreting tumor, such as a juxtaglomerular cell tumor, which is causing an increase in angiotensin II and aldosterone. This leads to vasoconstriction, fluid retention, and hypertension.

* The increased renin production on the left kidney is consistent with a renin-secreting tumor, which is a rare cause of secondary hypertension.
* The normal-sized right kidney suggests that the right kidney is not overproducing renin.
* The elevated blood pressure is likely due to the increased angiotensin II and aldosterone caused by the excess renin.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not explain the increased renal vein renin levels on the left kidney.
**Option B:** This option is incorrect because it does not account for the elevated serum renin levels.
**Option C:** This option is incorrect because it does not explain the normal-sized right kidney.

**Clinical Pearl / High-Yield Fact**
A renin-secreting tumor, such as a juxtaglomerular cell tumor, is a rare cause of secondary hypertension, and it can be diagnosed by measuring renal vein renin levels.

**Correct Answer:** C. Renal artery stenosis is not supported by the provided information.

✓ Correct Answer: C. Fibromuscular hyperplasia of the left renal aery