Pitfalls of Current Diagnostic Criteria of Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a well-recognized medical emergency in patients with cancer diagnosis. The diagnostic criteria of TLS have been revised many times since it was recognized, but still have many drawbacks that limit diagnosis accuracy.

Autopsy studies in patients with perimortem diagnoses of TLS have shown that they may not have actually had TLS. Therefore, in many cancer patients who are at risk for TLS, clinical and laboratory criteria may be fulfilled due to other causes of acute kidney injury. In this review, we aimed to cast a spotlight on the shortcomings and pitfalls of the current diagnostic criteria for TLS, and propose a roadmap for developing more rigorous criteria that improve on the diagnostic accuracy.

Causes of AKI in patients with cancer other than TLS should be considered. Because current diagnostic criteria may miss those differential diagnosis, specific biomarkers that can tell when TLS is the underlying process are an important need, besides appropriate criteria that can jump over the pitfalls in the current criteria and enhance the recognition of TLS among other causes.