Approach to acute renal failure with multiple myeloma: role of plasmapheresis.

Multiple myeloma is commonly complicated by renal failure, which limits therapeutic options and aggravates the prognosis. In myeloma the most common cause of advanced renal failure is myeloma kidney, where light chains produced by tumor cells precipitate and impede kidney function. We suggest that plasma exchange is an appropriate intervention in advanced renal failure from multiple myeloma, and support this notion with two case reports. The two elderly individuals had advanced chronic and acute renal failure, and recovered after the removal of large quantities of light chains by existing membrane separation techniques. We also present an algorithm to approach renal failure and myeloma.