Kidney failure is common among people living with multiple myeloma. As many as half of individuals with multiple myeloma experience problems with renal function, and approximately 10 percent develop kidney failure so severe that it requires dialysis.

Kidney failure symptoms may include itching, changes in the frequency of urination, and weakness. Kidney failure can result from abnormal proteins in the bloodstream.

"I had kidney failure before I got diagnosed," one MyMyelomaTeam member wrote. "I went to the hospital [and] they told me I had multiple myeloma."

“I just became alarmed because of the low kidney function,” another member posted.

Some of the symptoms of kidney failure can be downright alarming. “It started with blood in my urine,” one member commented.

What Causes Kidney Problems in Multiple Myeloma?

In people living with multiple myeloma, cancer cells secrete large quantities of antibodies. These are proteins created by the immune system, and when they function normally, they ward off infection. However, among those with multiple myeloma, the antibodies produced by the immune system are abnormal.

In some instances, having such a large quantity of abnormal antibodies can thicken the blood, a phenomenon known as hyperviscosity. This interferes with blood flow inside the kidney and can put people at increased risk for kidney injury.

The abnormal antibodies produced in multiple myeloma can be a primary contributor to the kidney problems people with this condition may experience.

Kidney damage in people with multiple myeloma can also be caused by the effect of monoclonal light chains, which are proteins produced by plasma cells. These proteins cause inflammation in both renal tubules (tubes in the kidneys that filter blood) and in the clusters of capillaries around the kidney tubule, known as glomeruli.

Another cause involves cast nephropathy, which is the formation of obstructions in the kidney tubules, caused by the aggregation of filtered free light chains, or plasma cell proteins.

What Are the Symptoms of Kidney Failure?

The early symptoms of kidney failure can include:

• Change in color of urine
• Change in frequency of urination
• Change in how food and beverages taste
• Confusion
• Fatigue
• High blood pressure
• Loss of appetite
• Nausea
• Shortness of breath
• Swelling in the face, feet, or hands
• Vomiting

People who don’t seek treatment when these features first present may eventually experience the later-stage symptoms of chronic kidney disease, or renal insufficiency. Some of these symptoms carry over from the early stages of renal failure, such as fatigue, inflammation, changes in frequency of urination, nausea, and shortness of breath.

The earlier these symptoms and common complications are addressed, the more likely it is that severe renal failure can be avoided.

Other symptoms of kidney failure can include:

• Bad breath
• Blood in the urine
• Dizziness
• Headaches
• Itchiness
• Lower back pain in the area of the kidneys
• Metallic taste
• Muscle soreness
• Poor growth (in children)
• Rashes
• Urine with a foamy appearance

How Are Kidney Issues Monitored and Managed?

Health care providers should intervene as early as possible when kidney damage is evident. Timely intervention is critical to managing kidney issues in people with multiple myeloma.

People with renal impairment and active multiple myeloma often manage their symptoms with Velcade (bortezomib). Others may be given a combination of medicines, including:

• Revlimid (lenalidomide) and Pomalyst (pomalidomide)
• Kyprolis (carfilzomib) and Ninlaro (ixazomib)
• Monoclonal antibodies, such as Empliciti (elotuzumab) and Darzalex (daratumumab)

Adequate hydration, correction of increased calcium and uric acid levels, and anti-myeloma therapy should be initiated promptly. Recovery of kidney function has been reported in a significant proportion of people, especially when high-dose Ozurdex (dexamethasone) is also used.

How Are Kidney Problems Treated?

Kidney disease in multiple myeloma is treated by addressing the cancer. When the myeloma is better controlled, kidney function typically improves, so treating the underlying illness is the first and most crucial step in addressing renal failure.

When someone has multiple myeloma alone, treatment usually comes in the form of chemotherapy, a stem cell transplant, or both. However, when kidney damage is present, a stem cell transplant is not typically recommended, so chemotherapy is the best option for treatment of multiple myeloma.

Medicines such as Ozurdex can be appropriate in treating people with multiple myeloma, sometimes in conjunction with Lipodox (doxorubicin).

Using certain medicines to manage the pain that often accompanies multiple myeloma can be a bad idea, as they can make kidney function worse. Talk to your doctor before starting any new medications. It’s also essential for people with multiple myeloma to remain hydrated by drinking two to three liters of water per day.

Does the Presence of Kidney Problems Influence Prognosis?

The presence of kidney problems is a significant prognostic factor in people with multiple myeloma. The degree of damage that the kidneys have sustained directly correlates to a person’s survival rate.

People with multiple myeloma and persistent kidney dysfunction have an average survival rate of slightly less than two years. Those without it have an average survival rate of between three and four years.

People taking certain drugs to treat multiple myeloma, such as bisphosphonates, should be closely monitored, as these medications may affect renal function.

Despite these outcomes, people with multiple myeloma and kidney damage have reason to be optimistic about the reversibility of their symptoms.

MyMyelomaTeam members encourage each other to gain as much of an understanding about their conditions as possible. “I have not had [blood in my urine], but I have heard of it happening,” one MyMyelomaTeam member said.

Another member said that a multidisciplinary approach encapsulating urology, nephrology, and oncology gave him good results. “The first course showed a spectacular positive result in the decline of [myeloma protein].”

Members also recommend remaining vigilant about side effects after being prescribed certain medicines for multiple myeloma. “I have end-stage renal disease, and it was caused by a combination of the advanced multiple myeloma I had and the chemotherapy I was taking,” one MyMyelomaTeam member said.

Your health care team can help you find strategies to manage your kidney function. Some members have found that certain drug combinations significantly improved their conditions.

Talk With Others Who Understand

MyMyelomaTeam is the social network and online community for those living with multiple myeloma and their loved ones. On MyMyelomaTeam, you gain a support group more than 9,600 members strong. Kidney damage and kidney failure are two of the most discussed topics.

How does kidney damage affect your daily life? Has your oncologist found the right treatment options to manage your kidney failure? Are you worried about an upcoming renal biopsy? Share your tips and experiences in a comment below, or start a conversation by posting on MyMyelomaTeam.