TUMOR LYSIS SYNDROME: ETIOLOGIES, PATIENT PROFILE, MANAGEMENT AND THERAPY (Atena Editora)

Abstract

Introduction: Tumor lysis syndrome (TLS) is an oncological emergency caused by the massive disintegration of tumor cells and the abrupt release of intracellular contents, such as potassium, phosphate and nucleic acid, into the bloodstream. Objectives: To present the main concepts of SLT, focusing on its etiologies, patient profile, management and therapy. Methodology: A narrative review of the literature was carried out based on 24 articles, which varied between 2016 and 2023. Results: TLS is an underreported oncological emergency that occurs after initiation of treatment for hematological malignancies. As etiologies, we can mainly mention chemotherapy. Its main risk factors include tumor characteristics such as metastatic disease and high proliferation rate. The pathophysiology directly correlates with the clinical picture, as it results from the release of potassium, phosphorus and nucleic acid ions into the bloodstream. The main manifestation of the disease may be acute kidney injury (AKI), caused by hyperuricemia or precipitation of calcium phosphate. For diagnosis and risk stratification of the syndrome, the Cairo and Bishop criteria are used, consisting of laboratory evaluation and the patient's clinical picture. The management of TLS must begin with the appropriate investigation of the disease by prior identification of the patient's profile and risk factors, looking for signs and symptoms such as weight loss, fever, bleeding and lymph node disease. The main approach is isotonic hydration. Conclusion: TLS is an oncological emergency and can be triggered by chemotherapy and spontaneous cell lysis. The clinical picture of the pathology presents with ARF, cardiac arrhythmias, nausea, vomiting, lethargy and sudden death. Management must be individualized and involves isotonic hydration and urate lowering. In case of refractory AKI, oral phosphate binders, diuretics and emergency hemodialysis can be adopted.