Table 2 Acute tumour lysis syndrome: associated malignancies, risk factors, clinical presentation and prophylactic treatment
From: Clinical review: Specific aspects of acute renal failure in cancer patients
Malignancies associated with TLS | |
|---|---|
High risk | High-grade non-Hodgkin's lymphoma |
Acute lymphoid leukaemia | |
Acute myeloid leukaemia | |
Intermediate risk | Myeloma |
Low-grade non-Hodgkin's lymphoma | |
Small-cell lung carcinoma | |
Low risk | Medulloblastoma |
Breast or gastrointestinal carcinoma | |
Risk factors | Tumour spread |
Rapid tumour growth | |
Chemosensitive tumour | |
LDH >1,500 IU/l | |
Hypokalaemia/hypophosphataemia | |
Pre-existing renal failure | |
Clinical presentation | |
Hyperkalaemia | Intracellular potassium release |
Hyperphosphataemia | Intracellular PO4- release |
Calcium phosphate deposition | |
Hypocalcaemia | Calcium phosphate deposition |
Rarely symptomatic | |
Hyperuricaemia | Nucleic acid degradation |
Acute renal failure | |
Prevention | Volume expansion |
Urate oxidase if risk factor for TLS | |
Urine alkalisation controversial | |
Do not correct hypocalcaemia if asymptomatic | |
If [calcium] × [phosphate] remains above 4.6 despite prophylactic measures, initiate renal replacement therapy | |
Avoid correction of hypokalaemia or hypophosphoraemia before induction |