Renal transplantation is generally not considered in patients with multiple myeloma (M.M.) because of their extremely poor prognosis but for patients in remission, it offers an alternative to dialysis. There are few reports of M.M. recurrence in kidney transplant recipients. We report a 57 year old white man with ESRD and Known multiple myeloma in remission who underwent Kidney transplantation. 18 months after transplantation in routine follow up; he was found to have elevated creatinin with no evidence of recurrence of myeloma in bone marrow aspiration. Renal biopsy was done; light microscopy and Immunoflorescence showed chronic scarring of the kidney due to cast nephropathy consistent with recurrence of multiple myeloma and repeat bone marrow aspiration after one week later confirmed this diagnosis. Review of the literature and prior studies suggest that it is reasonable to perform renal transplantation in patients with ESRD due to multiple myeloma in remission but large prospective studies would help to develop a strategy for prevention of multiple myeloma recurrence.