To the Editor.
—The article entitled "Identification of Risk for Renal Insufficiency From Nonsteroidal Anti-Inflammatory Drugs" by Blackshear et al1 in the June Archives was an excellent review. However, one clinical setting where reversible, as well as irreversible, acute renal failure has been precipitated by this class of drugs is multiple myeloma. This risk factor was not addressed.Since November 1982, we have encountered two cases of irreversible acute oliguric renal failure as well as two episodes of permanent worsening of renal function temporally related to the institution of nonsteroidal antiinflammatory drugs (NSAID) in patients with multiple myeloma. All four of these patients had known urinary excretion of free κ light chains. By chart review it was noted that all 12 patients with myeloma reviewed who excreted κ light chains had some degree of increase in levels of serum urea nitrogen and creatinine within four to seven days of initiation