title: A rare case of acute kidney injury associated with autoimmune hemolytic anemia and thrombocytopenia after long-term usage of oxaliplatin.
abstract: Oxaliplatin is effective in advanced colorectal cancer and is known to have relatively few side effects, such as hemolysis and renal toxicity. We report a case of acute kidney injury (AKI) after treatment with a combination of oxaliplatin, folinic acid and 5-fluorouracil or capecitabine. The patient developed acute renal failure, hemolytic anemia and thrombocytopenia after the 34th course of chemotherapy including oxaliplatin. A positive direct antiglobulin test and detection of immunoglobulin G and complement C3b and C3d on erythrocytes suggested the diagnosis of immune-related severe intravascular hemolytic anemia. She was successfully treated and recovered using plasma exchange, corticosteroids and hemodialysis therapy. Only seven other cases of AKI associated with oxaliplatin use have been reported to date. As in this case, acute hemolysis due to autoimmune mechanisms and subsequent AKI occurred suddenly after frequent use of oxaliplatin in four of those cases. We should be aware that oxaliplatin may cause sudden life-threatening hemolysis by drug-induced antibodies and subsequent AKI, even though oxaliplatin is frequently administered without side effects. This represents the first case report of AKI-related hemolysis due to oxaliplatin in Japan.
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. iisao@med.nagoya-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Ito
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yasuda
authors.forename: Takenori
authors.initials: T
authors.lastname: Ozaki
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kosugi
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Waichi
authors.initials: W
authors.lastname: Sato
authors.forename: Naotake
authors.initials: N
authors.lastname: Tsuboi
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology*; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000069287:Capecitabine; D003110:Colonic Neoplasms / Q000188:drug therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D011241:Prednisone / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil; D011241:Prednisone