DIAGNOSIS AND TREATMENT OF MYELOMA NEPHROPATHY IN THE ERA OF NEW THERAPEUTIC METHODS: A SYSTEMATIC REVIEW OF RECENT TRENDS

Abstract

Myeloma nephropathy (MN) is a common and severe complication of multiple myeloma (MM), found in up to 50% of patients at the time of diagnosis and associated with an increased risk of premature mortality [1]. The pathogenesis of MN is primarily due to the toxic effect of monoclonal free light chains of immunoglobulins (FLC) on the renal tubules, leading to their obstruction, inflammation, and the development of cast nephropathy [1, 2]. During 2023–2025, leading international organizations, such as the International Myeloma Working Group (IMWG) and the joint committee of the European Hematology Association and the European Myeloma Network (EHA–EMN), published updated clinical guidelines for managing this condition [1, 3]. Key innovations include the use of highly effective treatment regimens based on proteasome inhibitors, immunomodulators, and monoclonal antibodies, providing not only control of MM but also significant restoration of renal function due to the rapid reduction of nephrotoxic FLC levels [1, 3, 4]. Recent studies demonstrate improved outcomes, including a 76% overall renal response and no early mortality when using modern anti-myeloma drugs [4]. This review summarizes current data on the epidemiology, pathogenesis, diagnosis, and treatment of MN, with an emphasis on the latest approaches and response criteria outlined in the 2023–2025 guidelines, as well as the prospects for kidney transplantation in patients with deep remission [5].