What is the most common kidney related cancer emergency?
TLS is the most common oncologic emergency with an incidence as high as 26% in high-grade B-cell acute lymphoblastic leukemia.
TLS results from rapid release of intracellular contents of dying cancer cells into the bloodstream, either spontaneously or in response to cancer therapy. It is biochemically characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
Cardiac arrhythmias, seizures, and superimposed AKI are common clinical presentations. The pathophysiology of TLS-mediated AKI involves intratubular obstruction and inflammation by the precipitation of crystals of uric acid, calcium phosphate, and/or xanthine. Consensus recommendations for TLS prophylaxis include volume expansion for all risk groups, the use of allopurinol in medium- and high-risk groups, and the use of recombinant urate oxidase (rasburicase) in high-risk groups.
