Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 39-28: Hyperuricemia & Tumor Lysis Syndrome + Key Features Download Section PDF Listen +++ ++ Complication of treatment-associated tumor lysis of hematologic as well as rapidly proliferating malignancies May be worsened by thiazide diuretic use Rapid increase in serum uric acid can cause acute urate nephropathy from uric acid crystallization To prevent urate nephropathy, serum uric acid must be reduced before chemotherapy + Clinical Findings Download Section PDF Listen +++ ++ Acute kidney injury Hyperuricemia Hyperphosphatemia (associated symptoms include nausea, vomiting, seizures) Hyperkalemia (can cause arrhythmias and sudden death) + Diagnosis Download Section PDF Listen +++ ++ Laboratory tests (serum uric acid, phosphorus, calcium, electrolytes [particularly, potassium and sodium], creatinine) should be monitored following initiation of chemotherapy + Treatment Download Section PDF Listen +++ ++ Prevention of hyperuricemia, hyperphosphatemia and hyperkalemia are most important, though bicarbonate infusions are no longer recommended The American Society of Clinical Oncology guidelines recommend aggressive hydration before, during, and after chemotherapy to help keep urine flowing and facilitate excretion of uric acid and phosphorus Treatment for hyperuricemia Allopurinol Blocks the enzyme xanthine oxidase and therefore the formation of uric acid from purine breakdown 100 mg/m2 every 8 hours orally (maximum 800 mg/day) with dose adjustments for impaired kidney function should be given before starting chemotherapy Rasburicase Indicated for patients at high risk for developing tumor lysis syndrome or in whom hyperuricemia develops despite treatment with allopurinol Dosage: 0.1–0.2 mg/kg/day intravenously for 1–7 days Cannot be given to patients with known glucose 6-phosphate dehydrogenase (G6PD) deficiency nor can it be given to pregnant or lactating women Elevated potassium or phosphorus levels need to be promptly treated (see Hyperkalemia and Hyperphosphatemia)