A 44-Year-Old Man Who Was Recently Diagnosed with Idiopathic Membranous

A 44-year-old man who was recently diagnosed with idiopathic membranous nephropathy after developing edema comes to the office due to a sudden onset of left flank pain and gross hematuria.  The patient has no other medical problems.  He is taking furosemide and ramipril.  Blood pressure is 135/85 mm Hg and pulse is 88/min.  On examination, there is left flank tenderness.  The patient's edema has improved from the previous visit.  There is a left-sided varicocele that the patient has not noticed before.  Urinalysis shows increased proteinuria and new hematuria.  Serum lactate dehydrogenase is elevated.  Urinary loss of which of the following substances most likely predisposed this patient to his acute condition?

A) Albumin
B) Alpha-1 antitrypsin
C) Antithrombin III
D) Ceruloplasmin
E) Immunoglobulins
F) Lipoproteins

Correct Answer:

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