Significant renal dysfunction frequently develops in patients with multiple myeloma (MM) and is the second leading cause of death in addition to infection. Cast nephropathy is the most common cause of renal failure in MM patients. We reported a 39-year-old man with MM who presented with hypercalcemia and acute kidney injury (AKI). The renal pathology revealed microscopic nephrocalcinosis without evidence of myeloma casts nephropathy. The hypercalcemia was controlled and the renal dysfunction was reversed after medical treatment. Therefore, MM with AKI is a medical emergency that requires prompt diagnosis and intervention to avoid irreversible renal failure. (Acta Nephrologica 2011; 25: 141-143)
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