The latest article in our Current Concepts review series, The Tumor Lysis Syndrome, comes from Drs. Scott Howard Deborah Jones, and Ching-Hon Pui at the University of Tennessee Health Sciences Center.
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers.
• How does the clinical tumor lysis syndrome present?
Clinical tumor lysis syndrome is present when laboratory tumor lysis syndrome is accompanied by an increased creatinine level, seizures, cardiac dysrhythmia, or death.
• What are the laboratory features of the tumor lysis syndrome?
The tumor lysis syndrome occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy, leading to the characteristic findings of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
Figure 3. Assessment and Initial Management of the Tumor Lysis Syndrome.
Morning Report Questions
Q: How does the tumor lysis syndrome lead to kidney injury?
A: Hyperphosphatemia can precipitate as calcium phosphate crystals in various organs (e.g., the kidneys, where these crystals can cause acute kidney injury). Uric acid can induce acute kidney injury not only by intrarenal crystallization but also by crystal-independent mechanisms, such as renal vasoconstriction, impaired autoregulation, decreased renal blood flow, oxidation, and inflammation.
Q: How should patients at high risk for developing the tumor lysis syndrome be managed?
A: All patients who are at risk for the tumor lysis syndrome should receive intravenous hydration to rapidly improve renal perfusion and glomerular filtration and to minimize acidosis. Hydration is the preferred method of increasing urine output, but diuretics may also be necessary. Rasburicase is recommended as first-line treatment for patients who are at high risk for clinical tumor lysis syndrome. Because it is more difficult to correct hyperphosphatemia than hyperuricemia, urinary alkalinization should be avoided in patients with the tumor lysis syndrome, especially when rasburicase is available.