title: Tumor lysis syndrome: new challenges and recent advances.
abstract: Tumor lysis syndrome (TLS) is an oncologic emergency triggered by the rapid release of intracellular material from lysing malignant cells. Most common in rapidly growing hematologic malignancies, TLS has been reported in virtually every cancer type. Central to its pathogenesis is the rapid accumulation of uric acid derived from the breakdown of nucleic acids, which leads to kidney failure by various mechanisms. Kidney failure then limits the clearance of potassium, phosphorus, and uric acid leading to hyperkalemia, hyperphosphatemia, and secondary hypocalcemia, which can be fatal. Prevention of TLS may be more effective than treatment, and identification of at-risk individuals in whom to target preventative efforts remains a key research area. Herein, we discuss the pathophysiology, epidemiology, and treatment of TLS with an emphasis on the kidney manifestations of the disease.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: F Perry
authors.initials: FP
authors.lastname: Wilson
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: bernsj@uphs.upenn.edu.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berns
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism* / Q000628:therapy; D000493:Allopurinol / Q000627:therapeutic use; D001639:Bicarbonates / Q000627:therapeutic use; D002021:Buffers; D002118:Calcium / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D000069465:Febuxostat; D005440:Fluid Therapy; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D054559:Hyperphosphatemia / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D033461:Hyperuricemia / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D006996:Hypocalcemia / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D006435:Renal Dialysis; D013844:Thiazoles / Q000627:therapeutic use; D015275:Tumor Lysis Syndrome / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D014503:Urate Oxidase / Q000627:therapeutic use
chemical_list: D001639:Bicarbonates; D002021:Buffers; D004232:Diuretics; D004791:Enzyme Inhibitors; D013844:Thiazoles; C469709:rasburicase; D000069465:Febuxostat; D000493:Allopurinol; D014503:Urate Oxidase; D002118:Calcium
keywords: Acute kidney failure; Acute kidney injury; Oncologic emergencies; Rasburicase; Tumor lysis syndrome