however , oxaliplatin may rarely result in acute tubular necrosis ( atn ) , renal tubular acidosis [ 3 , 4 ] and hemolytic anemia with subsequent renal failure . our patient was a 67-year - old man known for colon adenocarcinoma , for which he received folfox chemotherapy ( leucovorin , fluorouracil , and oxaliplatin , 13 cycles ) and radiation before undergoing surgery . three years later , he was treated for two small spinal metastases , receiving 2 years of a - folfiri ( bevacizumab , leucovorin , fluorouracil , irinotecan ) , and a further 6 months of bevacizumab and capecitabine . folfox was restarted in september 2012 ; a first cycle was well tolerated . during the second cycle , however , shortly after the start of the oxaliplatin infusion , the infusion was stopped and these symptoms subsided ; when the infusion was restarted 30 min later , they quickly recurred . oxaliplatin was stopped and the patient received the remainder of his leucovorin and fluorouracil infusions without incident . four hours after receiving oxaliplatin , mr g. voided dark urine which was positive for blood on dipstick . the following day , at home he had acute kidney injury ( creatinine 1072 mol / l , from a baseline in the 80s ) . he remained oliguric in response to intravenous fluid administration and hemodialysis was initiated in due course . g / l ) and was thrombocytopenic ( platelet count 27  10/l ) and leukopenic ( wbc 1.7  10/l ) . his absolute neutrophil count continued to decrease , and he was admitted to hematology for febrile neutropenia . after endoscopy his lower gi bleed was attributed to angiodysplasia at the anastomotic site of his prior bowel resection . although he was initially dialysis dependent , he gradually recovered his renal function , and by 1 month post - discharge his creatinine had fallen to 97 mol / l . oxaliplatin - induced acute kidney injury is a rare event , with only 10 cases previously reported ( table 1 ) . in six , hemolysis and a positive dat suggested atn as a consequence of immune - mediated hemolysis [ 2 , 610 ] , which has been described as a result of oxaliplatin - dependent anti - rbc antibodies [ 7 , 8 ] . in the three cases where dat was confirmed negative , renal biopsy was suggestive of atn as a direct drug effect [ 1113 ] . of cycles oxaliplatin previously receivedpresenting symptomshemoglobinuria?change in creatinine ( mmol / l)change in hemoglobin ( g / l)other markers of hemolysisdat positive?required dialysis?outcome ( renal function only)pathologic diagnosis2002pinotti et al.16abdominal pain , feveryes 7.3 mg / dlnanananorecoveredatn2005labaye et al.10nana73  1126 98nanoyesrecoveredatn2006dahabreh et al.4discolored urineyes1.1 mg / dl 3.1 mg / dl138  120fragmented rbc , elevated ldh , elevated indirect bilirubinnonorecoveredna2009phan et al.5low back pain , dark urine , oliguriana68 1078142  107increased ldh , schiztocytesnoyesrecoveredatn1999desrame et al.41back pain , fever , chills , schleral icterus , dark urinena 471119  48elevated ldh , bilirubin , absent haptoglobinyesyesno recoveryna2003hofheinz et al.5dark urine , jaundicena 631104  67elevated ldhyesnorecoveredna2007cobo et al.14low back pain , dark urine , oliguriayes1.5  7.5 mg / dl123  84elevated ldhyesnorecoveredna2007buti et al.10nana 7.08 mg / dl112  86nayesnanana2010ulusakarya et al.12abdominal pain , fever , chillsyes 359128  113haptoglobin decreased , ldh increasedyesyesrecoveredna2012ito et al.33back painyes0.65  8.8 mg / dl82  56low haptoglobin , elevated ldhyesyesrecoverednacases are divided on the basis of direct antigen test result ; highlighted cases are those in which pathological diagnosis was obtained.na , not available ; rbc , red blood cells.abstracted from another reference . previously reported cases of acute kidney injury after oxaliplatin administration cases are divided on the basis of direct antigen test result ; highlighted cases are those in which pathological diagnosis was obtained . na , not available ; rbc , red blood cells . abstracted from another reference . atn via direct tubular toxicity is most consistent with the laboratory and pathological findings in this case . we believe this to be the fourth case of biopsy - proven atn as a consequence of oxaliplatin - mediated tubular toxicity . in common with previously reported cases , in contrast to previously reported cases , our patient was found to be glucose-6-phosphate dehydrogenase deficient . the g6pd deficiency in our patient could potentially have provided an alternative mechanism for hemolysis - induced atn but the normal serological markers of hemolysis do not support this possibility . it is also unclear whether our patient 's prolonged exposure to oxaliplatin placed him at a higher risk of aki  while prolonged exposure has been implicated as a risk factor for oxaliplatin - dependent immune - mediated hemolysis , previously reported cases of oxaliplatin - induced atn have been observed after as few as four cycles of treatment [ 9 , 11 , 14 ] . oxaliplatin - induced atn is thus a rare but serious complication of the commonly used folfox chemotherapy regimen .
a 67-year - old man known for metastatic colon cancer received treatment with oxaliplatin and developed severe acute kidney injury requiring dialysis . 
 renal biopsy revealed severe acute tubular necrosis . 
 acute kidney injury is a rare but severe adverse effect of oxaliplatin administration .