Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 3-4, Pages: 232-239
https://doi.org/10.2298/SARH1604232P
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Cited by
Acute renal failure in patients with tumour lysis sindrome
Poskurica Mileta (Clinical Centre Kragujevac, Department of Urology and Nephrology, Kragujevac + Faculty of Medical Sciences, Kragujevac)
Petrović Dejan (Clinical Centre Kragujevac, Department of Urology and Nephrology, Kragujevac + Faculty of Medical Sciences, Kragujevac)
Poskurica Mina (Faculty of Medical Sciences, Kragujevac)
Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al.), as
well as solid tumours (renal, liver, lung, ovarian, etc.), can lead to acute
or chronic renal failure. The most common clinical manifestation is acute
renal failure within the tumour lysis syndrome (TLS). It is characterized by
specific laboratory and clinical criteria in order to prove that kidney
disorders result from cytolysis of tumour cells after chemotherapy regimen
given, although on significantly fewer occasions it is likely to occur
spontaneously or after radiotherapy. Essentially, failure is the disorder of
functionally conserved kidney or of kidney with varying degrees of renal
insufficiency, which render the kidney impaired and unable to effectively
eliminate the end products of massive cytolysis and to correct the resulting
disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and
others. The risk of TLS depends on tumour size, proliferative potential of
malignant cells, renal function and the presence of accompanying diseases and
disorders. Hydration providing adequate diuresis and administration of
urinary suppressants (allopurinol, febuxostat) significantly reduce the risk
of developing TLS. If prevention of renal impairment isn’t possible, the
treatment should be supplemented with hemodynamic monitoring and
pharmacological support, with the possible application of recombinant
urate-oxidase enzyme (rasburicase). Depending on the severity of azotemia and
hydroelectrolytic disorders, application of some of the methods of renal
replacement therapy may be considered.
Keywords: malignant disease, acute renal failure, tumour lysis syndrome