Multiple myeloma is a malignant neoplasm leading to a variety of renal diseases. Although most patients have only one pattern of renal pathology, two or more patterns can exist in some patients. Here, we report a 61-year-old man with multiple myeloma developed proteinuria, hematuria, hypertension, and renal insufficiency. A combined presentation of light- and heavy-chain deposition disease and immunotactoid glomerulopathy was proved by kidney biopsy. Treatment of multiple myeloma resulted in a complete resolution of the renal manifestations. This case illustrates the complexity of paraprotein associated renal lesions and emphasizes that further studies examining the physiologic properties and pathologic effects of monoclonal immunoglobulin are needed.