RENAL insufficiency, a common and important complication of multiple myeloma, is generally attributed to the damaging effects of Bence Jones protein on tubular function.1 The pathophysiology of this type of renal failure must be better understood, if better therapeutic and prophylactic measures are to be devised. Although the renal failure in multiple myeloma is generally chronic and progressive, in rare instances acute failure may occur.
The present report describes a patient with unsuspected myeloma who died with acute renal failure following dehydration and pneumonia. In addition, the chief pathogenetic factors in the development of the acute and chronic renal failure of myeloma are presented and previously reported cases of acute renal failure complicating myeloma are reviewed. The importance of oliguria and aciduria in the tubular precipitation of Bence Jones protein is pointed out. Maintenance of diuresis and neutral or alkaline urines is suggested for the treatment and prevention