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Tumor Lysis Syndrome

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Onconephrology

Abstract

Tumor lysis syndrome (TLS) refers to the constellation of chemical and clinical abnormalities caused by the release of intracellular content from dying tumor cells. This has been described when high-grade, large-volume tumors are treated with chemotherapy, radiotherapy, or embolization, but can also occur spontaneously in the case of tumors with high intrinsic growth rates. The major intracellular elements are potassium (leading to hyperkalemia), phosphate (leading to hyperphosphatemia and hypocalcemia), and nucleic acids, which are metabolized to uric acid and other products. These products of nucleic acid metabolism can form crystals in the urine and cause obstruction to urinary flow, one of the important mechanisms of acute kidney injury (AKI) in TLS. Prevention and treatment of TLS requires recognition of at-risk patients and the use of volume expansion, allopurinol, and rasburicase as indicated.

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Abbreviations

TLS:

Tumor lysis syndrome

AKI:

Acute kidney injury

ALL:

Acute lymphoblastic leukemia

CML:

Chronic myelogenous leukemia

NHL:

Non-Hodgkin’s lymphoma

CLL:

Chronic lymphocytic leukemia

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Acknowledgment

All pathology figures in this chapter were provided by Dr. Isaac E. Stillman, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.

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Authors and Affiliations

  1. Division of Nephrology, Tufts University School of Medicine, 800 Washington St, Box 391, 02111, Boston, MA, USA

    Scott J. Gilbert MD & Seth Wright MD

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Correspondence to Scott J. Gilbert MD .

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Editors and Affiliations

  1. Department of Medicine, Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore LIJ School of Medicine, Great Neck, New York, USA

    Kenar D. Jhaveri

  2. Nephrology Section, General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Abdulla K. Salahudeen

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Gilbert, S., Wright, S. (2015). Tumor Lysis Syndrome. In: Jhaveri, K., Salahudeen, A. (eds) Onconephrology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2659-6_8

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