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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
  1. LDH, lactate dehydrogenase; TLS, tumour lysis syndrome.