Patients with multiple myeloma may present a variety of renal manifestations as a result of damage from circulating light chain immunoglobulin components. The renal alterations can interest any of the renal compartments, and in certain cases more than one compartment can be affected. The resulting high serum concentrations of these proteins often lead to tubular interstitial injuries as endocytic receptors in the proximal tubules are overwhelmed. A 46-year-old white man with a history of left hip pain was diagnosed as multiple myeloma. Imaging including MRI and PET scan showed a left pelvic heterogenous mass causing bone destruction and compressing the adjacent organs. He was referred to the nephrology department due to the onset of acute kidney injury requiring hemodialysis. A kidney biopsy was performed and showed patterns of acute interstitial nephritis and focal linear staining for kappa light chains along tubular basement membranes on immunofluorescence. After glucocorticoids for acute interstitial nephritis and chemotherapy (Bortezomib -Cyclophosphamide - Dexamethasone) directed against the clone, the renal function partially improved and the patient got off hemodialysis support. Conclusion: Acute kidney injury may be the first clinical presentation in patients with multiple myeloma. Could interstitial nephritis be the only manifestation of MM without myeloma cast nephropathy and whether it was glucocorticoid or chemotherapy directed against the clone that has resulted in a significant improvement in renal function.