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Tumor lysis syndrome (TLS): caused by release of tumor cell contents either from spontaneous cell lysis or in response to therapy. Characteristic findings: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia. Can lead to downstream effects: renal insufficiency, cardiac arrhythmia, seizures , death (due to multiorgan failure). Dying cells release cytokines which may cause a systemic inflammatory response syndrome and multiorgan failure. Occurs most frequently in patients with high grade non-Hodgkin lymphoma and acute leukemia. Other tumors can also be implicated. Patients at highest risk having pre-existing: chronic renal insufficiency, oliguria, dehydration, hypotension, acidic urine. Management directed toward, metabolic and renal complications through supportive care. Distinction between \'laboratory\' TLS and \'clinical\' TLS: \'laboratory\' TLS requires two or more of the following abnormalities within 3 days before and 7 days after starting therapy: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia; \'clinical\' TLS occurs when \'laboratory\' TLS has been established and is also accompanied by: increased creatinine level, seizures, cardiac dysrhythmia, or death. Renal injury is an important aspect of the disorder; occurs when calcium phosphate, xanthine and uric acid precipitate in renal tubules leading to obstruction and inflammation.
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