Kidney injury is a common complication of symptomatic multiple myeloma (MM) and has an impact on the survival of patients. Cast nephropathy (myeloma kidney) is the most common cause of severe kidney dysfunction in MM. Hypercalcemia, hyperuricemia, volume depletion, usage of nephrotoxic agents and radiocontrast are the other non-myeloma specific reasons for kidney injury. Recent advances in chemotherapeutic agents, stem cell transplantation, plasma exchange and dialysis techniques seem to improve survival of MM and the prognosis of myeloma-associated kidney injury. However, responsiveness to treatment differs considerably among patients because of the high heterogeneity of myeloma. Herein, we review different forms of renal involvement and current therapeutic approaches in patients with myeloma.