[The treatment of renal failure in multiple myeloma]

While in some patients, renal failure is the only, isolated sign of multiple myeloma, other patients have further simultaneous symptoms (signs of bone destruction, hypercalcaemia, cytopenia). Therefore, differential diagnosis of renal failure should always include monoclonal gametopathy-associated nephropathy. Renal damage is caused dominantly by free light chains. Elevated early mortality reaches 30% during the first 3 months and complicates treatment of patients with multiple myeloma with renal failure. More serious the renal damage caused by monoclonal immunoglobulin is, less likely is the improvement of renal function following treatment. Early diagnosis at the time when renal impairment is still reversible is extremely important for the patient's prognosis. Treatment regimens with high-dose glucocorticoids form the basis of treatment. Combined treatments with new, highly effective drugs (bortezomib or thalidomide) with high-dose glucocorticoids and an alkylating cytostatic agent, or with doxorubicin, have the fastest onset of action and thus provide the highest likelihood that haematological treatment response will be followed by improved renal function. High-dose chemotherapy is recommended in patients with persisting renal failure, particularly in the subgroup of patients with chemotherapy-sensitive disease; melphalan dose should not exceed 140 mg/m2.