Tumour lysis syndrome

Med Clin (Barc). 2019 May 17;152(10):397-404. doi: 10.1016/j.medcli.2018.10.029. Epub 2019 Jan 3.
[Article in English, Spanish]

Abstract

Tumour lysis syndrome (TLS) is a life-threatening emergency characterised by a massive cytolysis with the release of intracellular electrolytes, nucleic acids, and metabolites into the circulation. TLS comprises laboratory derangements (hyperuricaemia, hyperkalaemia, hyperphosphataemia, and hypocalcaemia) responsible for acute kidney injury. In patients with hematologic malignancies after cytotoxic therapy or spontaneously and also in advanced solid tumours. Assessment of disease specific risk level for TLS in patients receiving anti-tumoural therapy is essential for early diagnosis. Prophylaxis is the mainstay of management of TLS. It is important to routinely initiate a risk-adapted prophylactic strategy to correct metabolic alterations and preserve renal function. High and intermediate risk patients and patients with established TLS should be managed with multidisciplinary medical care in a hospital unit to receive monitoring and medical care. Renal replacement therapy should be considered in patients with refractory TLS.

Keywords: Acute renal failure; Insuficiencia renal aguda; Rasburicasa; Rasburicase; Síndrome de lisis tumoral; Tumour lysis syndrome.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / prevention & control
  • Acute Kidney Injury / therapy
  • Allopurinol / therapeutic use
  • Combined Modality Therapy
  • Fluid Therapy
  • Humans
  • Hyperkalemia / drug therapy
  • Hyperkalemia / etiology
  • Hyperphosphatemia / drug therapy
  • Hyperphosphatemia / etiology
  • Hyperuricemia / complications
  • Hyperuricemia / drug therapy
  • Hypocalcemia / drug therapy
  • Hypocalcemia / etiology
  • Prognosis
  • Renal Replacement Therapy
  • Risk Factors
  • Severity of Illness Index
  • Tumor Lysis Syndrome* / complications
  • Tumor Lysis Syndrome* / physiopathology
  • Tumor Lysis Syndrome* / prevention & control
  • Tumor Lysis Syndrome* / therapy
  • Urate Oxidase / therapeutic use

Substances

  • rasburicase
  • Allopurinol
  • Urate Oxidase