案例：患者，男，48岁。间歇性浮肿10余年，伴恶心、呕吐1周。血压155/110mmHg。血常规Hb80g/L。尿常规尿蛋白（++)，颗粒管型2-3/HP。血Cr485μmol/L。原发病的诊断可能是

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