Hyperuricemic syndromes in cancer patients

Tumor lysis syndrome is a challenging complication of cancer therapy. This review focuses on the risk factors and pathologies of patients at risk for hyperuricemic complications.

A review of the literature was performed that included original articles and related reviews from MEDLINE (PubMed) and published abstracts of meeting presentations.

Both host-related and tumor-related factors predispose cancer patients to hyperuricemic syndromes. Host-related factors include low urinary flow, pre-existing hyperuricemia, renal failure, dehydration, acidic urine, and suppressed renal uric acid excretion. Tumor-related risk factors include a high tumor cell proliferation rate, large tumor burden, and tumor chemosensitivity. Acute renal failure may occur after cytoreductive chemotherapy in patients with active disease and a high tumor burden. Patients with advanced Burkitt's leukemia/lymphoma, high-grade lymphoma, or acute leukemia with elevated leukocyte counts are at high risk for complications of hyperuricemia. The use of nonrecombinant (uricozyme) or recombinant urate oxidase to prevent or treat urate nephropathy may improve the outcome of patients.

Early recognition of metabolic abnormalities in cancer patients at risk for hyperuricemia is essential for proper therapy. Prospective studies to assess the incidence of and risk factors for hyperuricemic syndromes in patients treated with uricolytic agents are needed.