15th July 2024

Treatment

Initially, treatment should be centred on correcting volume depletion and electrolyte imbalances if present. Nephrotoxic agents should be withheld, particularly loop diuretics as they may precipitate cast formation. NICE recommends commencing a Bortezomib and Dexamethasone combination regimen for those with untreated newly diagnosed renal failure caused by multiple myeloma.

Ultimately, the treatment of myeloma related nephropathy hinges on the reduction of the paraprotein burden by chemotherapy.  In extreme circumstances, there may be a role for plasma exchange.