This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Chemotherapy, Subject name: Pharmacology
A patient receiving cisplatin, vinblastine, and bleomycin for a testicular neoplasm develops renal impairment. This is the effect of which drug(s) 
Select and explain. 
A. Cisplatin only, B. Bleomycin only, C. Vinblastine only, D. Both cisplatin and vinblastine
A: Cisplatin only
Answer: A: Cisplatin only 
Explanation: 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. Ref: katzung 12th ed. , chemotherapy of cancer