8th July 2024

A 72-year-old lady is admitted with a fall and back pain. She is otherwise well with no past medical history

A 72-year-old lady is admitted with a fall and back pain. She is otherwise well with no past medical history and is not on any medication. On admission, her blood results were as follows:

Haemoglobin: 122 g/L (115-165)

White cell count: 10.6 x 10⁹/L (4.0–11.0)

Platelet count: 360 x 10⁹/L (150-400)

Serum urea: 6.5 mmol/L (2.5-7.0)

Serum creatinine: 108 μmol/L (60–110)

Serum eGFR: 24 mL/minute/1.73 m²

Serum corrected calcium: 2.5 mmol/L (2.20-2.60)

Serum phosphate: 1.20 mmol/L (0.80-1.45)

Serum alkaline phosphatase: 126 U/L (45-105)

Serum 25-OH-cholecalciferol: 64 nmol/L (>50)

These were repeated 2 weeks later and remained largely identical despite IV fluid resuscitation. She is well in herself with no complaints and is ‘unsure what all the fuss is about’.

What is the most appropriate next step in the investigation of her reduced eGFR?

Select the SINGLE most appropriate option from the list below. Select ONE option only.