Renal Dysfunction - Multiple Myeloma Center for Nurses

Renal Dysfunction

Renal Dysfunction

Renal dysfunction is a myeloma-defining event characterized by elevated serum creatinine or impaired creatinine clearance.1

It is caused by overproduction of monoclonal light chains, which damages the kidneys.2,3


  • Between 15% and 40% of patients experience this complication due to hypercalcemia and protein deposition
  • Renal impairment is increasingly reversible due to more effective antimyeloma therapies and improvements in supportive care

Common Signs and Symptoms3

  • Anemia
  • Fatigue
  • Malaise
  • Fluid and electrolyte imbalances
  • Decreased urination


Serum creatinine

  • Defined as >2 mg/dL (>177 μmol/L)1

Creatinine clearance

  • Defined as <40 mL/min (volume of plasma cleared of creatinine)1
  • Provides estimation of glomerular filtration rate1
  • Can be measured by 24-hour urine collection3
  • Can be determined via the Cockcroft-Gault equation3


  • Evaluate associated signs and symptoms
  • Review medications for aggravating therapies
  • Monitor aggravating health conditions, such as diabetes or hypertension
  • Assess light-chain proteinuria to help distinguish between nonparaprotein-related causes and light-chain–induced renal impairment

For Your Patients3

  • Explain the symptoms of renal dysfunction and the importance of reporting them
  • Encourage appropriate patients to engage in:
    • Exercise
    • Weight control
    • Smoking cessation
    • Adherence to blood pressure and blood sugar medications
  • Discuss how renal function may affect the ability to receive certain antimyeloma treatments


  1. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548.
  2. Tricot G. Clinical manifestations. In: Hoffman R, Furie B, Benz EJ, McGlave P, Silberstein LE, Shattil SJ. Hematology: Basic Principles and Practice. 5th ed. New York, NY: Churchill Livingstone; 2008.
  3. Faiman B, Doss D, Colson K, et al; and the International Myeloma Foundation Nurse Leadership Board. Renal, GI, and peripheral nerves; evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 suppl):19-36.
  4. Dimopoulos DA, Terpos E, Chanan-Khan A, et al. Renal impairment in patients with multiple myeloma: a consensus statement on behalf of the International Myeloma Working Group. J Clin Oncol. 2010;28(33):4976-4984.