Multiple myeloma (MM) is associated with a high incidence of renal impairment, which correlates with decreased overall survival and increased risk of early mortality in these patients. In recent years, there has been great progress in the treatment of MM, and new drugs and therapies have improved prognosis of the patients. However, the prognosis of MM patients with concurrent renal impairment remains poorer compared with those with normal renal function. This article reviews the advancements in treatment and relevant strategies for MM patients with renal impairment. Current research supports the regime of combining monoclonal antibodies with proteasome inhibitors or immunomodulatory drugs in MM treatment. Chimeric antigen receptor T cells therapy, T-cell directing bispecific antibodies and antibody-drug conjugates have only been evaluated in small-scale retrospective studies for patients with renal impairment. Although the benefits of mechanical approaches aiming at rapid clearance of free light chains, such as plasmapheresis and high-cutoff hemodialysis, have not been confirmed, they may provide opportunities for renal recovery as combing with chemotherapy. The efficacy and safety of treatment in MM patients with renal impairment should be proactively assessed in prospective randomized controlled trials.