EMmedonline

• Tumor lysis syndrome is characterised by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia and is caused by the destruction of a large no. of rapidly proliferating neoplastic cells.

• Acidosis and acute renal failure may also develop.

• It is often associated with burkitt's lymphoma, ALL & other rapidly proliferating lymphomas. It is associated with administration of glucocorticoids, hormonal agents like letrozole & tamoxifen; monoclonal antibodies like rituximab.

• Hyperuricemia is produced due to destruction of malignant cells. The uric acid can precipitate in tubules , medulla and collecting ducts of the kidney, leading to renal failure.

• Hyperphosphatemia is due to release of intracellular pool of phosphate due to tumor lysis. This causes reciprocal depression of calcium. Deposition of calcium and phosphorus in the kidney can cause renal failure.

• Prognosis is excellent and renal function recovers after the uric acid is lowered to <10mg/dl.

Investigations

Investigations

• RFT

• Electrolytes

• USG/ CT to look for any obstructive cause for renal failure

• LDH will be elevated.

Management

• Hydration : NS or ½ NS at 3000ml/m² per day .

• Sodium bicarbonate can be administrated to keep pH>7.0.

• Allopurinol may be started 3 days prior to chemotherapy and continued for 10-14 days.

• Rasburicase

  • It is recombinant urate oxidase .It catalyzes enzymatic coversion of poorly soluble uric acid into inactive and more soluble metabolite (allantoin).

  • Indication : Serum uric acid > 8mg/dl or serum creatinine > 1.8mg/dl inspite of hydration for 24 -48hrs.

  • Dose: 0.2mg/kg over 30 min upto 5 days.

  • Administration and storage : Dilute with diluent available with the kit. Store the diluted drug at 2-8C for maximum 24hrs.

  • Adverse effects : Hypersensitivity, bronchospasm, hypoxemia, hypotension

  • Contraindication : G6PD deficiency

• Dialysis

  • Indication:

    • Serum uric acid >10 mg/dl

    • Serum creatinine >10mg/dl

    • Serum phosphate > 10mg/dl or increasing

    • Symptomatic hypocalcemia.

Reference

• Tinitinalli

• Harrison

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