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 125 her blood shuger is controled on antihypertensive and blood thinning and anti dietician tab. what is the most likely deferntial diagnosIs?
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