Tumour-Lysis-Syndrome

Tumour-Lysis-Syndrome

Tumour Lysis Syndrome
High sensitivity to treatment
Highly proliferative malignancy with ↑cell-turnover
Large tumour mass
Author: Joshua Yu Reviewers: Hannah Yaphe Davis Maclean Tejeswin Sharma Yan Yu* *Peter Duggan *ManChiu Poon *Lynn Savoie *Juliya Hemmett * MD at time of publication
High serum phosphate
High serum Advanced uric acid Age
Volume depletion
Pre-existing renal disease
Patient risk factors
Initiation of cancer treatment
Massive tumour cell lysis and release of cellular contents into circulation overwhelms homeostatic mechanisms
Tumour properties (hematologic malignancies most common)
Though rare, aggressive tumours can spontaneously lyse without treatment
Intracellular potassium released into bloodstream
Intracellular phosphate released
Hyperphosphatemia
↑ serum phosphate
Intracellular lactate dehydrogenase (LDH) released
↑ serum LDH
Intracellular nucleic acids released
Nucleic acids metabolized to uric acid
Hyperuricemia
↑ serum uric acid
Hyperkalemia
↑ serum potassium
(see Hyperkalemia: clinical findings)
Uric acid (a crystallizing substance) ↑ precipitation of calcium phosphate
↑ filtration of poorly soluble uric acid into acidic environment of renal tubules
Serum phosphate binds serum calcium, forming solid calcium phosphate precipitate crystals
High levels of calcium phosphate ↑ uric acid precipitation
Uric acid precipitates as crystals and deposits in kidney tubules and collecting ducts
Tubular injury and/or intraluminal obstruction
Endothelial dysfunction in renal vasculature
Renal inflammation, vasoconstriction, and
impaired renal vascular autoregulation
Decreased renal filtration
Acute Kidney Injury
(see Acute Kidney Injury Overview)
Crystal deposition in the heart
Depletion of soluble calcium
Hypocalcemia
Calcium phosphate crystals deposit in kidneys
Main mechanism of Acute Kidney Injury
Cardiac Arrythmias
↓ serum calcium
(see Hypocalcemia: clinical findings)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published October 25, 2020 on www.thecalgaryguide.com