Tumour Lysis Syndrome

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Tumour Lysis Syndrome
Dr Todd Fraser Intensive Care Unit The Geelong
Hospital
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The Problem

• Large number of dying cells
• Release of intracellular components into
  extracellular space
• Subsequent complications

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Who gets it?

• Most commonly associated with haematological
  malignancies
• Particularly if considered very sensitive
• Risk increased if
• older, younger
• pre-existing renal impairment
• pre-existing hyperuricaemia or hypocalaemia
• large tumour load

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What happens?

• Key players are
• urate
• phosphate
• calcium
• potassium
• lactic acidosis
• other
• Most significant outcome is renal failure

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Mechanisms of Renal Failure

• Precipitation of urate in kidneys
• Precipitation of calcium phosphate
• Precipitation of xanthine crystals
• Polyuria and dehydration
• Toxic metabolites of cells
• Nephrotoxic drugs

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Prevention

• 3 tenets
• Promotion of urine output
• Hydration
• Frusemide
• Reduce Urate load
• allopurinol
• urate oxidase
• Alkalinise urine
• sodium bicarb
• ural

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Diagnosis

• Clinical Context
• Collection of metabolic problems
• Urate crystals in urine
• Urinary urate Cr
• DDx include tumour infiltrate of renal
  parenchyma, and drug-related rhabdomyolysis

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Other problems

• Hypocalcaemia
• Intravenous Ca
• Aluminium hydroxide

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Possible Indications for CVVHD

• Usual
• Unresponsive hyperuricaemia or hyperphosphataemia
• Symptomatic hypocalcaemia in setting of
  hyperphosphataemia

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Summary

• Uncommon
• Life threatening metabolic disorder
• Prevention is key
• Alkalinisation is debatable