Multiple myeloma is a cancer of plasma cells in the bone marrow, and kidney involvement is one of its common complications. In some people, kidney problems are the first sign that leads to the diagnosis. Prompt joint care by a haematologist or oncologist and a nephrologist can improve the chances of kidney recovery.
How Multiple Myeloma Affects the Kidneys
Myeloma cells produce large amounts of abnormal proteins called light chains. These are filtered by the kidneys and can block or damage the tubules, a condition known as cast nephropathy or myeloma kidney.
The kidneys may also be affected in other ways, and the treating team will try to identify the exact mechanism, as it influences treatment.
- Light chain cast nephropathy (myeloma kidney)
- High calcium levels in the blood
- Dehydration and infections
- Amyloidosis or light chain deposition disease affecting the kidney filters
- Some painkillers, contrast dyes and other medicines that can add to kidney injury
Risk Factors
Multiple myeloma is more common in older adults. Certain factors may increase the chance of kidney involvement in people with myeloma.
- High levels of free light chains in the blood
- Dehydration from vomiting, fever or poor intake
- Raised blood calcium
- Use of NSAID painkillers for bone pain
- Infections and exposure to contrast dyes
Symptoms
Symptoms may come from the myeloma itself or from kidney dysfunction.
- Persistent back or bone pain
- Tiredness and weakness due to anaemia
- Reduced urine output or swelling of the legs
- Frothy urine
- Excessive thirst, constipation or confusion from high calcium
- Frequent infections
Diagnosis
Unexplained kidney failure in an older adult, especially with anaemia or bone pain, may prompt tests for myeloma. These can include serum and urine protein electrophoresis, serum free light chain measurement, calcium, kidney function tests and urine tests. A bone marrow examination is performed by the haematology team to confirm myeloma. A kidney biopsy may be advised to clarify the type of kidney involvement.
Treatment
Treatment of the myeloma itself is directed by the haematologist or oncologist. Rapidly lowering light chain levels is often the most important step for kidney recovery. The nephrologist focuses on supporting and protecting the kidneys during this time.
Because the kidneys may recover over weeks to months, regular blood tests are used to track progress and to adjust medicine doses as function changes. Patients who have had kidney involvement usually continue under nephrology follow-up during and after myeloma treatment. Drinking adequate fluids as advised, avoiding self-medication and reporting fever or reduced urine early can help prevent further kidney injury.
- Early start of myeloma-directed therapy by the haematology team
- Adequate hydration and correction of high calcium
- Avoiding NSAID painkillers and minimising contrast dye exposure where possible
- Adjusting medicine doses for kidney function
- Treating infections promptly
- Dialysis support when kidney function is severely reduced, which may be temporary in some patients
When to See a Nephrologist
A nephrologist should be involved if a person with myeloma has a rising creatinine, reduced urine output, significant protein in the urine or high calcium. Equally, anyone with unexplained kidney failure along with anaemia or bone pain should be evaluated promptly.
Frequently Asked Questions
Can kidney function recover in multiple myeloma?
In some patients, kidney function improves substantially once light chain levels fall with treatment, especially when therapy is started early. Recovery varies from person to person.
Will I need dialysis?
Not everyone does. Dialysis may be needed if kidney function falls severely, and in some patients it can later be stopped if the kidneys recover.
Which painkillers are safe for bone pain in myeloma?
NSAID painkillers are generally avoided because they can harm the kidneys. Your doctors will suggest kidney-friendly options for pain relief.
Who treats the myeloma, and who treats the kidneys?
The haematologist or oncologist treats the myeloma, while the nephrologist manages kidney complications. They work together and share decisions.
Consult Dr. Satarupa Deb
If you or a family member has multiple myeloma with kidney concerns, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai, who will coordinate care with your haematology team.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.