Steroid pulses and plasmapheresis in the treatment of acute renal failure in multiple myeloma.

Four patients with acute renal failure due to myeloma (IgG with lambda, lambda, lambda, IgG with kappa) were studied; serum creatinine was 4.7, 5.9, 4.25, 10.8 mg%, and proteinuria 2.1, 2.8, 5.2, 4.2g/24h respectively. Renal biopsy specimens (3 patients) showed interstitial fibrosis, oedema, infiltration of mononuclear cells, tubular atrophy or dilatation with many 'myeloma kidney' casts. The patients were treated with plasmapheresis (2-4 exchanges) and methylprednisolone pulses (three to four 1g pulses). Maintenance therapy included prednisone, vincristine, melphalan and cyclophosphamide. After a follow up of 26, 17, 8, 6 months respectively, serum creatinine levels are 1.7, 2.4, 1.8, 4.2mg% respectively. Proteinuria disappeared after three months of therapy in 3 patients, and then remained absent for the successive follow up.