Renal impairment is a very serious cause of multiple myeloma and can quickly become a medical emergency. Kidney failure is also one way that patients often first present with the disease. Addressing this issue, the International Myeloma Working Group (IMWG)has developed practical recommendations for the diagnosis and management of multiple myeloma-related renal impairment. The group based its recommendations on published data through December 2015, and they were created using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. The recommendations for testing are quite technical and detailed, so if you are experiencing renal failure caused by multiple myeloma, we recommend that you print the article in its entirety and take it with you to your doctor to discuss details and how it affects you. The team segmented its recommendations it categories Grade A, B and C, which are included in the linked article, International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. They include (but are not segmented here for simplicity's sake:

• All patients with myeloma at diagnosis and at disease assessment should have a series of specific tests, which are specifically listed.
• Bortezomib-based regimens remain the cornerstone of the management of myeloma-related renal impairment.
• In select patients with creatinine function at specific levels, carfilzomib can be safely administered. Other patients may receive lenalidomide and dexamethasone as part of their treatment.
• High fluid intake along with antimyeloma therapy is indicated.
• High-dose dexamethasone should be administered at least for the first month of therapy.
• Thalidomide is effective in patients with myeloma and renal impairment and no dose modifications are required.
• For patients with mild-to-moderate renal impairment, lenalidomide is generally safe and effective.
• For patients with severe renal impairment or those who are on dialysis, lenalidomide should be administered with close monitoring for hematologic toxicity; doses can be reduced as needed.
• High-dose therapy with autologous stem cell transplantation is feasible.

1. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment [published online ahead of print March 14, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.65.0044.