3 Months Unresponsive To in Medicine / Internal Medicine — 60yo Man | Nephrology | SMLE Q#12392
SMLE Question #12392
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 60-year-old man has persistent dull lower back pain for 3 months unresponsive to NSAIDs and increasing fatigue. He reports nocturia twice nightly. Examination shows mild lumbar bony tenderness. Recent tests show anaemia, mild hypercalcaemia, and rising serum creatinine. Bone marrow examination shows 20% clonal plasma cells. What is the most likely cause of this patient’s worsening kidney function?
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