Multiple myeloma (MM) is a common hematologic malignancy, and has renal involvement in up to 50% of cases. Patients with myeloma-related end-stage renal disease (ESRD) have a higher mortality rate compared to other patients with ESRD. Myeloma-related kidney disease (MRKD) has a variety of presentations, and the pathogenesis has become increasingly well understood. Proteosome inhibitor (PI)-based triple therapy has become the standard of care for patients with MRKD. The inhibition of NF-kB by PIs may have a reno-protective effect independent of their effect on malignant plasma cells. High dose dexamethasone during the first month of therapy (concurrent with effective chemotherapy) improves outcomes. Despite recent clinical trials, the utility of extracorporeal therapy with high cut-off filters for the clearance of free light chains is still debatable. Newer targeted therapies have recently been introduced for patients that have progressed through standard treatment. Novel therapies directed against the formation of casts or light chain amyloid deposits are under investigation.
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