Current approach to diagnosis and management of acute renal failure in myeloma patients

Adv Chronic Kidney Dis. 2012 Sep;19(5):297-302. doi: 10.1053/j.ackd.2012.06.001.


Renal impairment is a serious complication of multiple myeloma. The primary cause of renal failure in myeloma is damage to the kidney by excessive amounts of light chain produced by the myeloma tumor, giving rise to cast nephropathy (myeloma kidney), although there are several other important precipitants. Significantly poor prognosis is observed in patients who do not recover their renal function; however, with the advent of more effective therapies and a greater understanding of the pathogenesis of the underlying process, it has become possible to reverse renal impairment in greater numbers of patients. Determining whether the renal impairment is due to cast nephropathy should be the first priority, and once the diagnosis is confirmed, appropriate treatment should be initiated without delay. Reduction of serum free light chain is the key to recovery of renal function in these patients. The role of chemotherapy and extracorporeal removal of light chain are discussed.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / therapy*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Diphosphonates / therapeutic use
  • Fluid Therapy
  • Humans
  • Hypercalcemia / complications
  • Hypercalcemia / drug therapy
  • Multiple Myeloma / complications
  • Multiple Myeloma / therapy*
  • Plasmapheresis
  • Renal Dialysis
  • Risk Assessment


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antineoplastic Agents
  • Diphosphonates