Lipid Biochemistry USMLE Step 1 Practice Question
A 35-year-old man with chronic kidney disease (stage 4, GFR 28 mL/min) presents with LDL cholesterol of 145 mg/dL despite a statin. His triglycerides are elevated at 280 mg/dL, and HDL is low at 32 mg/dL. The nephrologist notes elevated serum lipoprotein(a) and urinary loss of apolipoprotein. Which lipoprotein abnormality is most likely secondary to his renal disease?
Answer choices
- ADecreased apolipoprotein A-I and A-II synthesis, reducing HDL formationCorrect answer
- BPrimary overproduction of lipoprotein(a) by hepatocytes due to inflammation
- CIncreased urinary clearance of LDL particles causing selective hyperlipidemia
- DImpaired lipoprotein lipase activity independent of apoC-II levels
- EDeficiency of LCAT secondary to loss of albumin in proteinuria
- FEnhanced hepatic synthesis of apolipoprotein B-100 secondary to decreased renal catabolism of triglyceride-rich lipoproteins
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