Cisplatin
Platinol · Platinum agent
Proximal tubular ATN + magnesium wasting; the archetype.
ATNLYTEPRE
SevereOpen →
Platinum agent
Oxaliplatin
Eloxatin · Oxali
The renal-sparing platinum — neuropathy is its hallmark, not nephrotoxicity.
MildThird-generation platinum · approved 2002
ColorectalGastricPancreatic
Signature kidney injury
Acute Tubular Necrosis
Representative incidence2%
Lowest nephrotoxic potential of the platinums; AKI is rare and case-level, often immune-mediated.
Source: Gupta et al., Adv Chronic Kidney Dis 2021
Toxicity fingerprint
Tap a signature to trace where it strikes the nephron.
0%incidence
SeverityMild
ReversibilityReversible
Evidence0 refs
Nephron map
Glomerulus
Vasculature / Endothelium
Proximal TubuleBulk reabsorption + drug uptake (OCT2, OATs)
Distal Tubule / Collecting DuctFine-tuning of Na, K, Mg, acid & water
Acute Tubular Necrosis
Direct death of tubular epithelial cells — the dose-limiting lesion of the platinums and zoledronate.
Mechanism of kidney injury
Lower proximal tubular accumulation than cisplatin. Rare immune-mediated reactions (drug-dependent antibodies) can cause acute hemolysis with pigment/TMA AKI, classically on re-exposure.
Clinical presentation
Usually no significant renal change; peripheral neuropathy dominates. Rare acute hemolysis with hemoglobinuria and AKI.
Onset
Acute if immune-mediated (often on re-challenge).
Reversibility
Reversible
Anticancer mechanism
DACH-platinum forming DNA cross-links; the backbone of FOLFOX colorectal regimens.
Management
Stop drug, supportive care, transfusion if hemolysis.
Risk factors
- Repeated exposure (immune reactions)
- Pre-existing CKD
Prevention
- Standard hydration
- Vigilance for immune hemolysis on re-challenge
Note · Often the platinum of choice in established CKD.
Where it strikes
Nephron segments
Proximal Tubule
Bulk reabsorption + drug uptake (OCT2, OATs)
Vasculature / Endothelium
Glomerular & peritubular capillaries
Injury signatures
Acute Tubular NecrosisThrombotic Microangiopathy
Beyond the kidney
Class-level context for the major non-renal toxicities of platinum agents.
Neurologic
Neuropathy, encephalopathy, ICANS, PRES
- Peripheral neuropathy (esp. oxaliplatin) and ototoxicity (cisplatin)
Hematologic
Cytopenias, thrombosis, TMA
- Myelosuppression — thrombocytopenia prominent with carboplatin
Gastrointestinal
Diarrhea, colitis, mucositis, perforation
- Severe nausea and vomiting
Evidence
4 peer-reviewed references. Citation metadata via PubMed / NLM.
PMIDBiopsy-proven first dose of oxaliplatin-induced acute tubular necrosis leading to end-stage renal failure: a case report.Soma Y et al. · BMC Nephrol 2023 · PMID 36978021Rare pathology-confirmed irreversible ATN/ESRD after a single dose.PMIDOxaliplatin-induced renal tubular vacuolization.Joybari AY et al. · Ann Pharmacother 2014 · PMID 24615628Describes the spectrum of oxaliplatin nephrotoxicity with biopsy correlation.PMIDNephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer.Jagieła J et al. · Int J Mol Sci 2021 · PMID 33924827Renal complications of FOLFOX regimens and dose adjustment.PMIDConventional Chemotherapy Nephrotoxicity.Gupta S et al. · Adv Chronic Kidney Dis 2021 · PMID 35190107Onconephrology review including oxaliplatin renal effects.
Related agents
Other agents sharing the same signature kidney injury.