Multifaceted Challenges of Multiple Myeloma: A Case of Renal Dysfunction in a young patient

Multiple Myeloma (MM) is a malignant plasma cell disorder characterized by systemic complications, including renal dysfunction and extramedullary manifestations. Renal impairment, particularly cast nephropathy, is a frequent and potentially severe complication of MM, contributing significantly to morbidity and mortality. A 30-year-old male presented with vomiting and was found to have acute kidney injury (AKI) with suspected progression to chronic kidney disease (CKD) Stage 5 A. Investigations revealed multiple myeloma with CRAB features—hypercalcemia, renal failure, anemia, and bone lesions. The patient was also HBsAg positive. Management included dialysis, supportive care, and medications such as dexamethasone and phosphate binders. Despite intensive treatment, persistent kidney dysfunction necessitated long-term dialysis. MM diagnosis involves comprehensive evaluation, including CRAB criteria and differentiation from related plasma cell disorders. Renal dysfunction in MM, primarily due to cast nephropathy, significantly affects treatment and prognosis. Advances in therapeutic approaches, including high-cutoff hemodialysis (HCO-HD) and chemotherapy, offer potential improvements in outcomes. However, patients progressing to end-stage renal disease (ESRD) require ongoing dialysis and tailored care. This case underscores the aggressive nature of MM with renal involvement and highlights the importance of early diagnosis, multidisciplinary management, and innovative therapeutic strategies. Regular monitoring and individualized treatment are critical to optimizing outcomes and improving survival in MM patients with renal complications. • MM often presents with renal dysfunction and CRAB features. • Patient (30 M) had vomiting, AKI progressing to CKD Stage 5 A. • Imaging revealed multiple lytic bone lesions; MM confirmed by bone marrow. • Persistent kidney failure required long-term dialysis despite therapy. • CAR T-cell therapy offers hope for refractory/young MM, but poses key risks.