Acute Kidney Injury and Tumor Lysis Syndrome

• Tumor lysis syndrome (TLS) is characterized by hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.
• Acute kidney injury in TLS increases patient mortality and can be caused by an obstructive uropathy from calcium phosphate crystalluria or uric acid crystal precipitation.
• Fluid resuscitation remains the primary treatment for TLS.
• Urine alkalinization, however, is no longer recommended, as it can result in calcium phosphate crystal precipitation. 
• Recombinant urate oxidase rapidly decreases uric acid levels and should be given to patients at high-risk for TLS and those with pre-existing kidney disease and high uric acid levels.

References

McCurdy MT, Shanholtz CB. Oncologic emergencies. Crit Care Med 2012; 40:2212-2222.