No votes yet


Renal Complications in Multiple Myeloma and Related Disorders

Beth M. Faiman
Patricia Mangan
Jacy Spong
Joseph D. Tariman
the International Myeloma Foundation Nurse Leadership Board
CJON 2011, 15(4), 66-76 DOI: 10.1188/11.CJON.S1.66-76

Kidney dysfunction is a common clinical feature of symptomatic multiple myeloma. Some degree of renal insufficiency or renal failure is present at diagnosis or will occur during the course of the disease and, if not reversed, will adversely affect overall survival and quality of life. Chronic insults to the kidneys from other illnesses, treatment, or multiple myeloma itself can further damage renal function and increase the risk for additional complications, such as anemia. Patients with multiple myeloma who have light chain (Bence Jones protein) proteinuria may experience renal failure or progress to end-stage renal disease (ESRD) and require dialysis because of light chain cast nephropathy. Kidney failure in patients with presumed multiple myeloma also may result from amyloidosis, light chain deposition disease, or acute tubular necrosis caused by nephrotoxic agents; therefore, identification of patients at risk for kidney damage is essential. The International Myeloma Foundation's Nurse Leadership Board has developed practice recommendations for screening renal function, identifying positive and negative contributing risk and environmental factors, selecting appropriate therapies and supportive care measures to decrease progression to ESRD, and enacting dialysis to reduce and manage renal complications in patients with multiple myeloma.


Attal, M., Cristini, C., Marit, G., Caillot, T., Facon, C., Hullin, P., … Harousseau, J.L. (2010). Lenalidomide maintenance after transplantation for myeloma. Retrieved from <a target="_blank" href='http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&c...

Attal, M., Harousseau, J.L., Facon, T., Guilhot, F., Doyen, C., Fuzibet, J.G., … Bataille, R. (2002). <i>Double autologous transplantation improves survival of multiple myeloma patients: Final analysis of a prospective randomized study of the Intergroupe Francophone du Myelome.</i> Retrieved from <a target="_blank" href='http://www.cancereducation.com/CancerSysPagesNB/abstracts/mmrf/31/AAVW1....

Attal, M., Harousseau, J.L., Facon, T., Guilhot, F., Doyen, C., Fuzibet, J.G., … Bataille, R. (2003). Single versus double autologous stem cell transplantation for multiple myeloma. <i>New England Journal of Medicine, 349</i>, 2495-2502.

Attal, M., Harousseau, J.L., Lewraz, S., Doven, C., Hulin, C., Benboubker, L., … Facon, T. (2006). Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. <i>Blood, 108</i>, 3289-3294.

Attal, M., Harousseau, J.L., Stoppa, A.M., Sotto, J.J., Fuzibet, J.G., Rossi, J.F., … Bataille, R. (1996). A prospective randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. <i>New England Journal of Medicine, 335</i>, 91-97.

Blade, J., Fernandez-Llama, P., Bosch, F., Montoliu, J., Lens, X.M., Montoto, S., … Monserrat, E. (1998). Renal failure in multiple myeloma: Presenting features and predictors of outcome in 94 patients from a single institution. <i>Archives of Internal Medicine, 158</i>, 1889-1893. doi:10.1001/archinte.158.17.1889

Blade, J., & Rosinol, L. (2005). Renal, hematologic, and infectious complications in multiple myeloma. <i>Best Practice and Research. Clinical Haematology, 18</i>, 635-652. doi:10.1016/j.beha .2005.01.013

Blade, J., Sonneveld, P., San Miguel, J.F., Sutherland, H.J., Hajek, R., Nagler, A., … DOXYL-MMY-3001 Study Investigators. (2008). Pegylated liposomal doxorubicin plus bortezomib in relapsed or refractory multiple myeloma: Efficacy and safety in patients with renal function impairment. <i>Clinical Lymphoma and Myeloma, 8</i>, 352-355. doi:10.3816/CLM.2008.n.051

Bradwell, A.R., Harding, S.J., Fourrier, N.J., Wallis G.L.F., Drayson, M.T., Carr-Smith, H.D., & Mead, G.P. (2009). Assessment of monoclonal gammopathies by nephelometric measurement of individual immunoglobulin kappa/lambda ratios. <i>Clinical Chemistry, 55</i>, 1646-1655. doi:10.1373/clinchem.2009.123828

Brater, D.C. (1999). Effects of nonsteroidal anti-inflammatory drugs on renal function: Focus of cyclooxygenase-2-selective inhibition. <i>AJN, 107</i>, 65-70.

Bridoux, F., Sirac, C., Hugue, V., Decourt, C., Thierry, A., Quellard, N., … Touchard, G. (2005). Fanconi's Syndrome induced by a monoclonal V3 light chain in Waldenström's macroglobulinemia. <i>American Journal of Kidney Diseases, 45</i>, 749-757. doi:10.1053/j.ajkd.2004.12.020

Celgene Corp. (2004). Alkeran® (melphalan) [Product information]. Summit, NJ: Author

Celgene Corp. (2010a). <i>Revlimid® (lenalidomide)</i> [Product information]. Warren, NJ: Author.

Celgene Corp. (2010b). <i>Thalomid® (thalidomide)</i> [Product information]. Summit, NJ: Author.

Chanan-Khan, A.A., Kaufman, J.L., Mehta, J., Richardson, P.G., Miller, K.C., Lonial, S., … Singhal, S. (2007). Activity and safety of bortezomib in multiple myeloma patients with advanced renal failure: A multicenter retrospective study. <i>Blood, 109</i>, 2604-2606. doi:10.1182/blood-2006-09-046409

Chanan-Khan, A.A., Miller, K.C., Musial, L., Padmanabhan, S., Yu, J., Ailawadhi, S., … Czuczman, M.S. (2009). Bortezomib in combination with pegylated liposomal doxorubicin and thalidomide is an effective steroid independent salvage regimen for patients with relapsed or refractory multiple myeloma: Results of a phase II clinical trial. <i>Leukemia and Lymphoma, 50</i>, 1096-1101. doi:10.1080/10428190902912460

Clark, W.F., & Garg, A.X. (2008). Plasma exchange for myeloma kidney: Cast(s) away? <i>Kidney International, 73</i>, 1211-1213. doi:10.1038/ki.2008.117

Clark, W.F., Stewart, A.K., Rock, G.A., Sternbach, M., Sutton, D.M., Barrett, B.J., … the Canadian Apheresis Group. (2005). Plasma exchange when myeloma presents as acute renal failure: A randomized, controlled trial. <i>Annals of Internal Medicine, 143</i>, 777-784.

Cook, R. (2008). Economic and clinical impact of multiple myeloma to managed care. <i>Journal of Managed Care Pharmacy, 14</i>(7, Suppl.), S19-S25.

Coward, R.A. (1989). The cost of chronic dialysis in multiple myeloma. <i>Postgraduate Medicine Journal, 65</i>, 302-306. doi:10.1136/pgmj.65.763.302

Dimopoulos, M., Alegre, A., Stadtmauer, E.A., Goldschmidt, H., Zonder, J.A., de Castro, C.M., … Weber, D.M. (2010). The efficacy and safety of lenalidomide plus dexamethasone in relapsed and/or refractory multiple myeloma patients with impaired renal function. <i>Cancer, 116</i>, 3807-3814. doi:10.1200/JCO.2010.30.8791

Dimopoulos, M., Spencer, A., Attal, M., Prince, H.M., Harousseau, J.L., Dmoszynska, A., … the Multiple Myeloma (010) Study Investigators. (2007). Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. <i>New England Journal of Medicine, 357</i>, 2123-2132. doi:10.1056/NEJMoa070594

Dimopoulos, M.A., Kastritis, E., Rosinol, L., Blade, J., & Ludwig, H. (2008). Pathogenesis and treatment of renal failure in multiple myeloma. <i>Leukemia, 22</i>, 1485-1493. doi:10.1038/leu.2008.131

Dimopoulos, M.A., Terpos, E., Chanan-Khan, A., Leung, N., Ludwig, H., Jagannath, S., … San Miguel, J. (2010). Renal impairment in patients with multiple myeloma: A consensus statement on behalf of the International Myeloma Working Group. <i>Journal of Clinical Oncology, 28</i>, 4976-4984. doi:10.1200/JCO.2010.30.8791

Dispenzieri, A., Kyle, R., Merlini, G., San Miguel, J., Ludwig, H, Hajek, R., … International Myeloma Working Group. (2009). International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. <i>Leukemia, 23</i>, 215-224.

Dispenzieri, A., Kyle, R.A., Katzmann, J.A., Therneau, T.M., Larson, D., Benson, J., … Rajkumar, S.V. (2008). Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma. <i>Blood, 111</i>, 785-789. doi:10.1038/leu.2008.307

Drayson, M., Tang, L.X., Drew, R., Mead, G.P., Carr-Smith, H., & Bradwell, A.R. (2001). Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. <i>Blood, 97</i>, 2900-2902. doi:10.1182/blood.V97.9.2900

Faiman, B., Bilotti, E., Mangan, P.A., Rogers, K., & the International Myeloma Foundation Nurse Leadership Board. (2008). Consensus statement for the management of steroid-associated side effects in patients with multiple myeloma. <i>Clinical Journal of Oncology Nursing, 12</i>(3, Suppl.), 53-62. doi:10.1188/08.CJON.S1.53-62

Finkelstein, F.O., Wuerth, D., & Finkelstein, S.H. (2009). Health-related quality of life and the CKD patient: Challenges for the nephrology community. <i>Kidney International, 76</i>, 946-952.

Firestone, B., & Mold, J.W. (2009). Type 2 diabetes: Which interventions best reduce absolute risks of adverse events? <i>Journal of Family Practice, 58</i>(6), E1-E10.

Gertz, M.A. (2002). Diagnosing primary amyloidosis. <i>Mayo Clinic Proceedings, 77</i>, 1278-1279. doi:10.4065/77.12.1278

Gertz, M.A. (2005). Managing myeloma kidney. <i>Annals of Internal Medicine, 143</i>, 835-837.

Hallan, S., Asberg, A., Lindberg, M., & Johnsen, H. (2004). Validation of the Modification of Diet in Renal Disease formula for estimating GFR with special emphasis on calibration of the serum creatinine assay. <i>American Journal of Kidney Diseases, 44</i>, 84-93.

Haroun, M.K., Jaar, B.G., Hoffman, S.C., Comstock, G.W., Klag, M.J., & Coresh, J. (2003). Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland. <i>Journal of the American Society of Nephrology, 14</i>, 2934-2941. doi:10.1097/01.ASN.0000095249.99803.85

Harousseau, J.L., Attal, M., Leleu, X., Troncy, J., Pegourie, B., Stoppa, A.M., … Avet-Loiseau, H. (2006). Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: Results of an IFM phase II study. <i>Haematologica, 91</i>, 1498-1505.

Herrera, C.M., Poblet, M.S., Cabrera, R., Pedrero, M.D., & Alonso, J.F. (2008). Light chain deposition disease. Experience in our environment. <i>Nefrologia, 28</i>, 539-542.

Hutchison, C.A., Bradwell, A.R., Cook, M., Basnayake, K., Basu, S., Harding, S., … Cockwell, P. (2009). Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis. <i>Clinical Journal of the American Society of Nephrology, 4</i>, 745-754. doi:10.2215/CJN.04590908

Jakubowiak, A.J., Kendall, T., Al-Zoubi, A., Khaled, Y., Mineishi, S., Ahmed, A., … Kaminski, M.S. (2009). Phase II trial of combination therapy with bortezomib, pegylated liposomal doxorubicin, and dexamethasone in patients with newly diagnosed myeloma. <i>Journal of Clinical Oncology, 27</i>, 5015-5022. doi:10.1200/JCO.2008.19.5370

Kastritis, E., Anagnostopoulos, A., Roussou, M., Gika, D., Matsouka, C., Barmparousi, D., … Dimopoulos, A. (2007). Reversibility of renal failure in newly diagnosed multiple myeloma patients treated with high dose dexamethasone-containing regimens and the impact of novel agents. <i>Haematologica, 92</i>, 546-549.

Katodritou, E., Verrou, E., Hadjiaggelidou, C., Gastari, V., Laschos, K., Kontovinis L., … Zervas, K. (2008). Erythropoiesis-stimulating agents are associated with reduced survival in patients with multiple myeloma. <i>American Journal of Hematology, 83</i>, 697-701. doi:10.1002/ajh.21239

Knudsen, L.M., Hjorth, M., Hippe, E., & the Nordic Myeloma Study Group. (2000). Renal failure in multiple myeloma: Reversibility and impact on the prognosis. <i>European Journal of Haematology, 65</i>, 175-181. doi:10.1034/j.1600-0609.2000.90221.x

Kooman, J.P. (2009). Estimation of renal function in patients with chronic kidney disease. <i>Journal of Magnetic Resonance Imaging, 30</i>, 1341-1346. doi:10.1002/jmri.21970

Kuhnemund, A., Liebisch, P., Bauchmuller, K., zur Hausen, A., Veelken, H., Wasch, R., & Engelhardt, M. (2009). "Light-chain escape-multiple myeloma"—An escape phenomenon from plateau phase: Report of the largest patient series using LC-monitoring. <i>Journal of Cancer Research and Clinical Oncology, 135</i>, 477-484. doi:10.1007/s00432-008-0470-7

Kunin, M., Kopolovic, J., Avigdor, A., & Holtzman, E.J. (2004). Collapsing glomerulopathy induced by long-term treatment with standard-dose pamidronate in a myeloma patient. <i>Nephrology Dialysis Transplantation, 19</i>, 723-726.

Kyle, R.A., Yee, G.C., Somerfield, M.R., Flynn, P.J., Halabi, S., Jagannath, S., … Anderson, K. (2007). American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. <i>Journal of Clinical Oncology, 25</i>, 2464-2672. doi:10.1200/JCO.2007.12.1269

Leung, N., Gertz, M.A., Zeldenrust, S.R., Rajkumar, S.V., Dispenzieri, A., Fervenza, F.C., … Winters, J.L. (2008). Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains. <i>Kidney International, 73</i>, 1282-1288. doi:10.1038/ki.2008.108

Levey, A.S., Coresh, J., Balk, E., Kausz, A.T., Levin, A., Steffes, M.W., … Eknoyan, G. (2003). National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. <i>Annals of Internal Medicine, 139</i>, 137-147.

Malluche, H.H., Koszewski, N., Monier-Faugere, M.C., Williams, J.P., & Mawad, H. (2006). Influence of the parathyroid glands on bone metabolism. <i>European Journal of Clinical Investigation, 36</i>(Suppl. 2), 23-33. doi:10.1111/j.1365-2362.2006.01664.x

Malluche, H.H., Mawad, H.W., & Monier-Faugere, M.C. (2010). Renal osteodystrophy in the first decade of the new millennium-analysis of 630 bone biopsies in black and white patients. <i>Journal of Bone and Mineral Research.</i> Advanced online publication. doi:10.1002/jbmr.309

Markowitz, G.S., Fine, P.L., & D'Agati, V.D. (2002). Nephrotic syndrome after treatment with pamidronate. <i>American Journal of Kidney Diseases, 39</i>, 1118-1122.

McCarthy, P.L., Owzar, K., Anderson, K.C., Hofmeister, C.C., & Hurd, D.D. (2010). Phase III intergroup study of lenalidomide versus placebo maintenance therapy following single autologous stem cell transplant (ASCT) for multiple myeloma (MM). Retrieved from <a target="_blank" href='http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&c...

Miceli, T., Colson, K., Faiman, B., Miller, K., Tariman, J.D., & the International Myeloma Foundation Nurse Leadership Board. (2011). Maintaining bone health in patients with multiple myeloma: Survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. <i>Clinical Journal of Oncology Nursing, 15</i>(4, Supp.), 9-23.

Millennium: The Takeda Oncology Company. (2010). <i>Velcade® (bortezomib)</i> [Product information]. Cambridge, MA: Author.

National Comprehensive Cancer Network. (2010a). Clinical Practice Guidelines in Oncology™: Cancer- and chemotherapy-induced anemia [v.1.2011]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/f_guidelines.asp'>http:/...

National Comprehensive Cancer Network. (2010b). Clinical Practice Guidelines in Oncology™: Multiple myeloma [v.1.2011]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/f_guidelines.asp'>http:/...

National Kidney Foundation. (2010). About chronic kidney disease. Retrieved from <a target="_blank" href='http://www.kidney.org/professionals/KLS/aboutCKD.cfm'>http://www.kidney....

O'Seaghdha, C.M., Perkovic, V., Lam, T.H., McGinn, S., Barzi, F., Gu, D.F., … the Asia Pacific Cohort Studies Collaboration. (2009). Blood pressure is a major risk factor for renal death: An analysis of 560 352 participants from the Asia-Pacific region. <i>Hypertension, 54</i>, 509-515. doi:10.1161/HYPERTENSIONAHA.108.128413

Palumbo, A., & Rajkumar, S.V. (2009). Treatment of newly diagnosed myeloma. Leukemia, 23, 449-456. doi:10.1038/leu.2008.325

Penfield, J.G. (2006). Multiple myeloma in end-stage renal disease. <i>Seminars in Dialysis, 19</i>, 329-334.

Perazella, M.A., & Markowitz, G.S. (2008). Bisphosphonate nephrotoxicity. <i>Kidney International, 74</i>, 1385-1393.

Rajkumar, S.V., & Dispenzieri, A. (2008). Multiple myeloma. In M.D. Abeloff, J.O. Armitage, J.E. Niederhuber, M.E. Kastan, & W.G. McKenna (Eds.), <i>Abeloff clinical oncology</i> (4th ed., pp. 2323-2352). Philadelphia, PA: W.B. Saunders.

Rajkumar, S.V., Jacobus, S., Callander, N.S., Fonseca, R., Vesole, D.H., Williams, M.V., … the Eastern Cooperative Oncology Group. (2010). Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed myeloma: An open-label randomized controlled trial. <i>Lancet Oncology, 11</i>, 29-37. doi:10.1016/S1470-2045(09)70284-0

Rajkumar, S.V., & Kyle, R.A. (2005). Multiple myeloma: Diagnosis and treatment. <i>Mayo Clinic Proceedings, 80</i>, 1371-1382. doi:10.4065/80.10.1371

San Miguel, J.F., Schlag, R., Khuageva, N.K., Dimopoulos, M.A., Shpilberg, O., Kropff, M., … the VISTA Trial Investigators. (2008). Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. <i>New England Journal of Medicine, 359</i>, 906-917. doi:10.1056/NEJMoa0801479

Taheri, D., Chehrei, A., Fesharakizadeh, M., Seyrafean, S., Shahidi, S., & Emami, A. (2007). Recurrent multiple myeloma following renal transplantation: A case report. <i>Transplantation Proceedings, 39</i>, 1063-1065. doi:10.1016/j.transproceed.2007.02.015

Tariman, J., & Faiman, B. (2011). Multiple myeloma. In C.H. Yarbro, D. Wujcik, & B.H. Gobel (Eds.), <i>Cancer nursing: Principles and practice</i> (7th ed., pp. 1513-1545). Boston, MA: Jones and Bartlett.

Unger, E.F., Thompson, A.M., Blank, M.J., & Temple, R. (2010). Erythropoiesis-stimulating agents—Time for a re-evaluation. <i>New England Journal of Medicine, 362</i>, 189-192. doi:10.1056/NEJMp0912328

van Agthoven, M., Segeren, C.M., Buijt, I., Uyl-de Groot, C.A., van der Holt, B., Lokhorst, H.M., & Sonneveld, P. (2004). A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem cell rescue in newly diagnosed patients with stage II/III multiple myeloma: A prospective randomised phase III study. <i>European Journal of Cancer, 40</i>, 1159-1169. doi:10.1016/j.ejca.2004.01.019

Weber, D.M., Chen, C., Niesvizky, R., Wang, M., Belch, A., Stadtmauer, E.A., … the Multiple Myeloma (009) Study Investigators. (2007). Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. <i>New England Journal of Medicine, 357</i>, 2133-2142. doi:10.1056/NEJMoa 070596