65 u old female with a history of HTN

Patient: 65 u old female with a history of HTN &DM type 2 for more than 10 Y .ambitions of both leg Rte below the knee Rte above the knee.Rte side weekness after he morgue stroke 1 year ago.now C/o SOB .Chest X-ray show plural effusion bilateral. Developed ascites after 10 days . Herror Urea blood level is 125her blood shuger is controledon antihypertensive and blood thinning and anti dietician tab.what is the most likely deferntial diagnosIs?

Doctor: