A 46-Year-Old Man Comes to the Office Due to Bilateral

A 46-year-old man comes to the office due to bilateral ankle and facial swelling, especially prominent in the periorbital area.  He has no shortness of breath, fever, or changes in urine color.  The patient does not use tobacco, alcohol, or illicit drugs.  He has no significant medical history and takes no medications.  His temperature is 37.1 C (99 F) , blood pressure is 130/70 mm Hg, pulse is 78/min, and respirations are 14/min.  Examination shows bilateral 1+ pitting ankle edema.  Auscultation shows clear lungs, normal heart sounds, and no murmurs.  Dipstick urinalysis is positive for protein.  A 24-hour urine collection shows proteinuria of 4.6 g/day.  Laboratory results are as follows: Which of the following is the most likely cause of this patient's low serum calcium level?

A) Decreased 1-alpha-hydroxylation of 25-OH vitamin D
B) Decreased 25-hydroxylation of vitamin D
C) Decreased levels of parathyroid hormone
D) Decreased serum albumin
E) Normal levels of parathyroid hormone with impaired action at target organs

Correct Answer:

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