A 56-Year-Old Man with Chronic Kidney Disease Is Seen for a Routine

A 56-year-old man with chronic kidney disease is seen for a routine follow-up visit.  The patient also has type 2 diabetes, hypertension, and hyperlipidemia.  His serum creatinine level has been increasing over the past 2 years.  Blood pressure is 144/90 mm Hg and pulse is 88/min.  Weight is 80 kg (176 lb) .  Physical examination is normal except for trace pitting ankle edema.  Serum creatinine level is 1.8 mg/dL; 1 year ago, serum creatinine was 1.4 mg/dL.  Serum calcium and phosphorus levels are in the normal range.  Which of the following is most likely responsible for maintaining the serum phosphorus within normal range despite declining renal function?

A) Elevated serum thyrotropin
B) Hypocalcemia
C) Hypomagnesemia
D) Increased serum fibroblast growth factor 23 level
E) Suppressed serum parathyroid hormone level

Correct Answer:

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