{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:29:47Z","timestamp":1786480187696,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,6]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Kidney involvement in patients with multiple myeloma has many different findings in kidney histology.<\/jats:p>\n <\/jats:list-item>\n \n Persistent dialysis requirement is a major cause of mortality.<\/jats:p>\n <\/jats:list-item>\n \n The rapid initiation of modern myeloma therapy is essential to prevent the need for dialysis and reduce mortality.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Acute or CKD affects 20%\u201340% of patients with multiple myeloma (MM). While the negative prognostic effect of kidney involvement is established, the specific effect of different histological patterns remains poorly understood. We aimed to characterize the clinical outcomes associated with distinct kidney histologies in patients with MM.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We retrospectively analyzed 193 patients with MM who underwent kidney biopsy, comparing outcomes with 62 patients with MM without kidney disease. Patients were categorized by histological findings: cast nephropathy (CN,\n n<\/jats:italic>\n =120), lightchain (AL) amyloidosis (\n n<\/jats:italic>\n =19), monoclonal Ig deposition disease (MIDD,\n n<\/jats:italic>\n =8), and other renal disease (\n n<\/jats:italic>\n =46). We evaluated kidney function, dialysis requirements, treatment responses, and survival across histological subtypes and treatment modalities (conventional therapy versus modern agents including proteasome inhibitors, CD38 antibodies, and autologous stem cell transplantation).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The CN and MIDD groups had the lowest median eGFR at biopsy (13.0 and 25.5 ml\/min per 1.73 m\n 2<\/jats:sup>\n , respectively). Nephrotic-range proteinuria (>3.5 g\/24 hours per Kidney Disease Improving Global Outcomes) was observed in the AL amyloidosis group (median 3910 mg\/24 hours). KRT was initiated in 42.5% of patients. The proportion achieving KRT independence was 42.4% in the CN group and 50% in the other renal disease group, whereas none in the AL amyloidosis or MIDD groups recovered sufficient native kidney function. Modern combination therapy significantly improved renal outcomes, with 100% of patients receiving triple therapy showing renal response. KRT dependency was the strongest predictor of mortality: Patients remaining on KRT had significantly shorter survival compared with those never requiring KRT (12.7 versus 56.2 months,\n P<\/jats:italic>\n < 0.001). The extent of improvement in kidney function did not influence survival; only dialysis status was prognostically relevant.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Kidney histology determines distinct clinical trajectories in patients with MM, with CN showing potential for dialysis reversibility. Modern combination therapies significantly improve renal outcomes. The requirement for ongoing KRT was the primary predictor of overall survival.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001131","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T17:00:47Z","timestamp":1769792447000},"page":"1296-1306","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Kidney Histology and Choice of Treatment on Survival in Patients with Multiple Myeloma"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7919-237X","authenticated-orcid":false,"given":"David","family":"Klank","sequence":"first","affiliation":[{"name":"Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1364-4596","authenticated-orcid":false,"given":"Julian","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Institute for AI in Medicine, University Medicine Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6008-029X","authenticated-orcid":false,"given":"Lina","family":"R\u00fcsing","sequence":"additional","affiliation":[{"name":"Univ. Klinik f\u00fcr Innere Medizin I, Universit\u00e4tsklinikum AKH Wien, Wien, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0388-3098","authenticated-orcid":false,"given":"Clara","family":"Daschner","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Endocrinology, Hypertensiology and Rheumatology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7647-7265","authenticated-orcid":false,"given":"Stefan","family":"Porubsky","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Pathologie, Universit\u00e4tsklinikum Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5878-1147","authenticated-orcid":false,"given":"Peter","family":"Paschka","sequence":"additional","affiliation":[{"name":"Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9401-3811","authenticated-orcid":false,"given":"Christian","family":"L\u00f6ffler","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Endocrinology, Hypertensiology and Rheumatology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany"},{"name":"Klinik f\u00fcr Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, medius Klinik Kirchheim, Vaskulitis-Referenzzentrum ERN-RITA der Europ\u00e4ischen Union, Lehrkrankenhaus der Universit\u00e4t T\u00fcbingen, Kirchheim unter Teck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7965-1273","authenticated-orcid":false,"given":"Raoul","family":"Bergner","sequence":"additional","affiliation":[{"name":"Medizinische Klinik A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"issue":"2","key":"B1-20260625","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1080\/10428190601126602","article-title":"Renal failure in multiple myeloma: incidence, correlations, and prognostic significance","volume":"48","author":"Eleutherakis-Papaiakovou","year":"2007","journal-title":"Leuk Lymphoma."},{"issue":"36","key":"B2-20260625","doi-asserted-by":"crossref","first-page":"9219","DOI":"10.1200\/JCO.2005.03.2086","article-title":"Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United Kingdom Medical Research Council trials between 1980 and 2002 - Medical Research Council Adult Leukaemia Working Party","volume":"23","author":"Augustson","year":"2005","journal-title":"J Clin Oncol."},{"issue":"4","key":"B3-20260625","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000443492","article-title":"The prevalence and management of multiple myeloma-induced kidney disease in China","volume":"1","author":"Shi","year":"2016","journal-title":"Kidney Dis (Basel)."},{"issue":"3","key":"B4-20260625","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1093\/ndt\/gfz211","article-title":"Incidence, prognostic impact and clinical outcomes of renal impairment in patients with multiple myeloma: a population-based registry","volume":"36","author":"Courant","year":"2021","journal-title":"Nephrol Dial Transplant."},{"issue":"13","key":"B5-20260625","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1200\/JCO.2015.65.0044","article-title":"International Myeloma Working Group recommendations for the diagnosis and management of myeloma-related renal impairment","volume":"34","author":"Dimopoulos","year":"2016","journal-title":"J Clin Oncol."},{"issue":"8","key":"B6-20260625","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.3390\/diagnostics12081912","article-title":"Histological findings in kidney biopsies of patients with monoclonal gammopathy \u2014 always a Surprise","volume":"12","author":"Klank","year":"2022","journal-title":"Diagnostics."},{"issue":"1","key":"B7-20260625","doi-asserted-by":"crossref","first-page":"2399430","DOI":"10.1080\/16078454.2024.2399430","article-title":"Efficacy of daratumumab on multiple myeloma patients with renal insufficiency: a systematic review and meta-analysis","volume":"29","author":"Jiang","year":"2024","journal-title":"Hematology."},{"issue":"5","key":"B8-20260625","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/ajh.24335","article-title":"Bortezomib-based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis","volume":"91","author":"Dimopoulos","year":"2016","journal-title":"Am J Hematol."},{"issue":"2","key":"B9-20260625","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1038\/leu.2012.182","article-title":"The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma","volume":"27","author":"Dimopoulos","year":"2013","journal-title":"Leukemia."},{"issue":"6","key":"B10-20260625","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1080\/10428194.2020.1867725","article-title":"Renal insufficiency in multiple myeloma: a systematic review and meta-analysis of all randomized trials from 2005-2019","volume":"62","author":"Mohyuddin","year":"2021","journal-title":"Leuk Lymphoma."},{"issue":"11","key":"B11-20260625","first-page":"1555","article-title":"The outcome of autologous stem cell transplantation in patients with plasma cell disorders and dialysis-dependent renal failure","volume":"91","author":"Raab","year":"2006","journal-title":"Haematologica."},{"key":"B12-20260625","doi-asserted-by":"crossref","first-page":"7891","DOI":"10.2147\/CMAR.S212526","article-title":"Evaluating daratumumab in the treatment of multiple myeloma: safety, efficacy and place in therapy","volume":"12","author":"Dima","year":"2020","journal-title":"Cancer Manag Res."},{"issue":"8","key":"B13-20260625","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.3390\/ph17081029","article-title":"The role of monoclonal antibodies in the treatment of myeloma kidney disease","volume":"17","author":"Derudas","year":"2024","journal-title":"Pharmaceuticals (Basel)."},{"issue":"1","key":"B14-20260625","doi-asserted-by":"crossref","first-page":"2311600","DOI":"10.1080\/16078454.2024.2311600","article-title":"Renal outcome in multiple myeloma patients with cast nephropathy: a retrospective analysis of potential predictive values on clinical and renal outcome","volume":"29","author":"R\u00fcsing","year":"2024","journal-title":"Hematology."},{"issue":"suppl 1","key":"B15-20260625","doi-asserted-by":"crossref","first-page":"6913","DOI":"10.1182\/blood-2024-201472","article-title":"Survival of hemodialysis-dependent multiple myeloma patients and factors associated with dialysis Independence: a real-world study in China","volume":"144","author":"Wang","year":"2024","journal-title":"Blood."},{"issue":"3","key":"B16-20260625","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1159\/000441607","article-title":"Predictors and outcomes of post-hospitalization dialysis dependent acute kidney injury","volume":"131","author":"Gautam","year":"2015","journal-title":"Nephron."},{"issue":"6","key":"B17-20260625","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.3390\/jcm10061175","article-title":"Determinants of outcomes of acute kidney injury: clinical predictors and beyond","volume":"10","author":"Abdel-Rahman","year":"2021","journal-title":"J Clin Med."},{"issue":"3","key":"B18-20260625","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2215\/CJN.06290615","article-title":"Trends in survival and renal recovery in patients with multiple myeloma or light-chain amyloidosis on chronic dialysis","volume":"11","author":"Decourt","year":"2016","journal-title":"Clin J Am Soc Nephrol."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001131","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:56:33Z","timestamp":1786478193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000001131","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]},"assertion":[{"value":"2025-07-30","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}