Multiple myeloma with significant renal dysfunction: CrCl <60 mL/min or serum creatinine...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-MM-RENAL-DYSFUNCTION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-MM`
Sources	`SRC-ESMO-MM-2023` `SRC-NCCN-MM-2025`

Red Flag Origin

Definition	Multiple myeloma with significant renal dysfunction: CrCl <60 mL/min or serum creatinine >177 µmol/L (>2 mg/dL) attributable to myeloma kidney
Clinical direction	investigate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 60
    },
    {
      "comparator": ">",
      "finding": "serum_creatinine_mg_dl",
      "threshold": 2.0
    },
    {
      "finding": "mm_renal_failure",
      "value": true
    }
  ],
  "type": "lab_result"
}

Notes

Direction "investigate" — triggers lenalidomide dose adjustment in BOTH VRd and D-VRd and demands further workup (24-hr urine, kidney biopsy in selected cases) to distinguish myeloma kidney from other causes. Does not shift the algorithm's regimen choice (proteasome inhibitors are renal-safe and remain effective at recovering renal function), but mandates dose modification surfaced as a particularity in the rendered Plan. The schema enum doesn't have "dose_adjust" — "investigate" is the closest match per §9.

Used By

Algorithms

ALGO-MM-1L - ALGO-MM-1L

Indications

IND-MM-2L-DKD - IND-MM-2L-DKD
IND-MM-3L-ISA-KD - IND-MM-3L-ISA-KD
IND-MM-ELDERLY-FRAIL-VRD-LIGHT - IND-MM-ELDERLY-FRAIL-VRD-LIGHT

Questionnaires

QUEST-MM-1L - Multiple Myeloma — newly diagnosed (1L)

Red flag

RF-ORGAN-RENAL-IMPAIRED - Renal impairment requiring dose modification: moderate (CrCl 30-50 mL/min) or severe (CrC...