Clinical meaning
Oncologic emergency where cancer treatment destroys a large number of cells rapidly, releasing intracellular potassium, phosphate, and nucleic acids into circulation. Nucleic acids are metabolized to uric acid, which precipitates in renal tubules, causing acute kidney injury (AKI).
Diagnosis & workup
Diagnostics & workup: - Order BMP every 6-8 hours (K+, phosphorus, calcium, creatinine, uric acid) - Order LDH as a marker of cell turnover and tumor burden - Order uric acid level every 6-8 hours during active lysis - Order ECG for hyperkalemia assessment (peaked T waves, widened QRS) - Order urinalysis to assess for uric acid crystals and renal tubular damage - Calculate calcium x phosphate product (> 60 = calcification risk) - Order ABG for metabolic acidosis assessment - Consult nephrology early for potential dialysis need
Risk factors: - High tumor burden (bulky disease) - Rapidly proliferating malignancies (Burkitt lymphoma, ALL) - Elevated pre-treatment LDH and uric acid - Pre-existing renal impairment - Dehydration - Chemotherapy initiation (24-72 hours post) - High white cell count (> 50,000)