Multiple Myeloma and Kidney Disease

Multiple myeloma (MM) is the abnormal proliferation of plasma cells that leads to the production of monoclonal light chains. These light chains may cause renal disease by forming tubular casts (cast nephropathy), granular deposits (light chain deposition disease), or amyloid (AL amyloidosis). Approximately one-half of patients with MM will present with renal impairment. Up to 25% of patients that require dialysis on presentation will recover renal function after therapy. Stem cell transplant offers the best chance of survival for patients that are candidates. Newer therapies including lenalidomide and bortezomib have led to increased renal and overall response rates. Bisphosphonate therapy decreases the incidence of vertebral fractures, skeletal-related events and pain, but does not affect survival. Caution is advised with bisphosphonates given the risks of collapsing focal segmental glomerulosclerosis, acute tubular necrosis and osteonecrosis of the jaw. The optimal timing for kidney transplant in patients with MM is not entirely clear.