A patient receiving cisplatin, vinblastine, and bleomycin for a testicular neoplasm develops renal impairment. This is effect of which drug(s)?

Cisplatin can induce significant renal dysfunction, characterized by increased blood urea nitrogen and creatinine, and decreased creatinine clearance. These effects result from acure necrosis of the proximal and distal tubules with disruption of the brush border microvilli. Hydration with saline infusion or mannitol appears to protect against nephrotoxicity. Carboplatin is less nephrotoxic but causes more bone marrow sup­pression than cisplatin. Cisplatin also causes severe nausea and vomiting. Bleomycin and vinblastine are not usually associated with renal toxicity. Bleomycin causes allergic reactions, hypotension, edema, pulmo. nary fibrosis, and alopecia. Vinblastine may cause nau­sea and vomiting, alopecia, loss of reflexes, and bone marrow suppression.