[Tumor lysis syndrome: risk factors and treatment]

Tumor lysis syndrome is a typical oncological complication, characterized by hyperuricemia, hyperkalemia, hyperphosphatemia with secondary hypocalcemia, acidosis and acute renal failure. it occurs particularly in patients with lymphoproliferative diseases during therapy with potent myelosuppressive substances. patients with solid tumors rarely develop a tumor lysis syndrome during anti-neoplastic therapy (chemo-, hormonal-, steroid therapy, radiotherapy). host-related (e.g. pre-existing volume depletion, hyperuricemia, acidic urine) and tumor-related (e.g. large tumor burden, tumor sensitivity to therapy, advanced stage) risk factors contribute markedly to the development of tumor lysis syndrome. prophylaxis and treatment of tumor lysis syndrome consist of adequate hydration of the patients (3 l fluid/m2/day) in order to maintain urine production of > or =100 ml/h, controlled alkalinisation (urine pH 7.0-7.5) and, if necessary, extracorporeal therapy (intermittent or continuous hemodialysis or hemodiafiltration). recombinant urate oxidase (rasburicase) reduces uric acid values by far more effectively than allopurinol. treatment with rasburicase (01.-0.2 mg/kg for 1-7 days) does not only markedly reduce the incidence of tumor lysis syndrome in patients with malignancy but also morbidity and mortality. hyperphosphate-induced acute renal failure due to intrarenal calcium phosphate precipitation may, however, occur even during rasburicase therapy