Reversible renal insufficiency in multiple myeloma

• Forty-five patients met the criteria for the diagnosis of multiple myeloma in a retrospective chart review from 1975 to 1980. Renal insufficiency with peak serum creatinine concentration greater than 1.5 mg/dL involved 69% of all patients. Renal insufficiency was reversible in 55% of the cases. Treatment of hypercalcemia and/or chemotherapy for multiple myeloma was associated with reversibility in 88% of cases. Once renal insufficiency occurred in patients with multiple myeloma, those with reversible renal failure had a duration of survival fourfold longer (11.4v2.8 months) than those with Irreversible renal insufficiency. In conclusion, reversible renal insufficiency from hypercalcemia or the myeloma process itself develops in a majority of patients with multiple myeloma. If therapy reverses the renal dysfunction, a greater life expectancy occurs. Patients with multiple myeloma and renal insufficiency should, therefore, be examined for reversible causes of renal dysfunction, since if found and treated, a substantial improvement in prognosis is achieved. (Arch Intern Med1982;142:2083-2086)