A 67-year-old male patient developed multiple myeloma with acute renal failure caused by myeloma kidney. Although a very good partial response was achieved with bortezomib with dexamethasone (BD) therapy under temporary dialysis, relapse occurred 3 years later. Thalidomide was added to the BD therapy but was discontinued because of drug-induced eczema. Subsequently, bone lesions and chromosomal abnormalities appeared. Because renal failure progressed with increased serum free light chain levels, maintenance hemodialysis was introduced. Administration of lenalidomide showed no effect due to intolerance. BD therapy was re-started, but diffuse ground-glass opacity with pleural effusion was observed in both lungs, leading to the discontinuation of this treatment. Subsequently, pomalidomide with low-dose dexamethasone (PD) therapy was begun under hemodialysis. Seven cycles of PD therapy maintained disease stability. However, a dosage adjustment was needed because of pancytopenia. Maintaining the therapeutic effect apparently required a pomalidomide dose of 4 mg/day in this case. These findings suggest that pomalidomide is useful in relapsed or refractory advanced myeloma, with careful dose reductions and supportive care, even for patients with renal failure requiring hemodialysis.