Tumor Lysis Syndrome: An Endless Challenge in Onco-Nephrology

Abstract

Tumor lysis syndrome (TLS) is a common cause of acute kidney injury in patients with malignancies, and it is a frequent condition for which the nephrologist is consulted in the case of the hospitalized oncological patient. Recognizing the patients at risk of developing TLS is essential, and so is the prophylactic treatment. The initiation of treatment for TLS is a medical emergency that must be addressed in a multidisciplinary team (oncologist, nephrologist, critical care physician) in order to reduce the risk of death and that of chronic renal impairment. TLS can occur spontaneously in the case of high tumor burden or may be caused by the initiation of highly efficient anti-tumor therapies, such as chemotherapy, radiation therapy, dexamethasone, monoclonal antibodies, CAR-T therapy, or hematopoietic stem cell transplantation. It is caused by lysis of tumor cells and the release of cellular components in the circulation, resulting in electrolytes and metabolic disturbances that can lead to organ dysfunction and even death. The aim of this paper is to review the scientific data on the updated definition of TLS, epidemiology, pathogenesis, and recognition of patients at risk of developing TLS, as well as to point out the recent advances in TLS treatment.

Keywords: cancer; chemotherapy; toxicity; tumor lysis syndrome.

Figure 1

Pathogenesis of tumor lysis syndrome, resulting in acute kidney injury.

Figure 2

Uric acid metabolism and mechanisms of action of hypouricemic drugs. AMP—adenosine monophosphate; GMP—guanosine monophosphate; XO—xanthine oxydase; UO—urate oxydase.