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Kidney failure may develop both acutely and chronically.The most common cause of kidney failure in multiple myeloma is due to proteins secreted by the malignant cells.A selected group of patients with documented hypogammaglobulinemia may benefit from replacement immunoglobulin therapy to reduce the risk of infection.

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Headache, visual changes, and retinopathy may be the result of hyperviscosity of the blood depending on the properties of the paraprotein.

Finally, radicular pain, loss of bowel or bladder control (due to involvement of spinal cord leading to cord compression) or carpal tunnel syndrome, and other neuropathies (due to infiltration of peripheral nerves by amyloid) may occur.

The anemia found in myeloma is usually normocytic and normochromic.

It results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal red blood cell production (hematopoiesis) by cytokines.

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Persistent localized pain may indicate a pathological bone fracture.

Involvement of the vertebrae may lead to spinal cord compression or kyphosis.

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It may give rise to paraplegia in late-presenting cases.

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