Tumor lysis syndrome and prevention of kidney damage

Author:  Maria Yiallouros, Editor:  PD Dr. med. Gesche Tallen, Reviewer:  Prof. Dr. med. Dr. h.c. Günter Henze, English Translation:  Hannah McRae, Last modification: 2014/05/21 https://kinderkrebsinfo.de/doi/e80554

Tumor lysis syndrome (TLS) is defined as the metabolic consequences from the death of cancer cells by chemotherapy. TLS commonly occurs in patients with cancers that grow fast, are big or disseminated widely, respectively, and that are highly sensitive to anticancer drugs, such as leukemias and lymphomas.

The underlying problem is, that when cells die, their contents, such as potassium, uric acid, phosphate and various proteins, to name a few, is released into the circulation. Hence, after death of a huge number of cancer cells, the patient's organism is usually overwhelmed by the volume of waste products. For example, excess uric acid (hyperuricemia) forms crystals that accumulate in the renal tubules, thereby causing considerable damage to the kidneys. Life-threatening kidney failure can be the result.

In order to prevent such kidney damage, patients who are at risk for TLS usually receive large volumes of fluid (called hydration) during the first phases of anticancer treatment. These fluids are given intravenously (IV). They contain ingredients that help preventing the crystallization of uric acid.

Patients may also receive additional drugs such as allopurinol or rasburicase that either block uric acid production or promote the conversion of uric acid to a more water-soluble, thus less kidney-damaging molecule, respectively.