Oxaliplatin-induced acute renal failure presenting clinically as thrombotic microangiopathy: think of acute tubular necrosis

A 65-year-old male with advanced colorectal cancer treated by sigmoidectomy and FOLFOX 6 regimen was admitted to the ICU after five cycles because of anuric acute renal failure (ARF) and thrombocytopenia (Table 1). Chemotherapy consisted in a combination of OXP, 5-fluorouracil (5-FU) and folinic acid. He had received a total dosage of 470 mg of OXP when shortly after the last infusion he complained of intense lower back pain and developed oliguria with dark urine. On ICU admission, physical examination was unremarkable. Renal ultrasonography findings including Doppler assessment of artery flow were normal. Bonemarrow aspiration finding was consistent with peripheral thrombocytopenia. Because of hyperkalaemia, emergency intermittent haemodialysis was started. A direct anti-globulin test was negative (eluate assay was not performed). There were no anti-HLA antibodies. Low levels of circulating platelet antibodies were observed, but detection of OXP-dependent anti-platelet antibodies was not performed. Blood cultures were sterile.