Tumour lysis syndrome.

IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Scott C Howard, Anna Avagyan, Biruh Workeneh, Ching-Hon Pui
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引用次数: 0

Abstract

Tumour lysis syndrome (TLS) represents a critical oncological emergency characterized by extensive tumour cell breakdown, leading to the swift release of intracellular contents into the systemic circulation, outpacing homeostatic mechanisms. This process results in hyperuricaemia (a by-product of intracellular DNA release), hyperkalaemia, hyperphosphataemia, hypocalcaemia and the accumulation of xanthine. These electrolyte and metabolic imbalances pose a significant risk of acute kidney injury, cardiac arrhythmias, seizures, multiorgan failure and, rarely, death. While TLS can occur spontaneously, it usually arises shortly after the initiation of effective treatment, particularly in patients with a large cancer cell mass (defined as ≥500 g or ≥300 g/m2 of body surface area in children). To prevent TLS, close monitoring and hydration to improve renal perfusion and urine output and to minimize uric acid or calcium phosphate precipitation in renal tubules are essential. Intervention is based on the risk of a patient of having TLS and can include rasburicase and allopurinol. Xanthine, typically enzymatically converted to uric acid, can accumulate when xanthine oxidases, such as allopurinol, are administered during TLS management. Whether measurement of xanthine is clinically useful to optimize the use of allopurinol or rasburicase remains to be determined.

Abstract Image

肿瘤溶解综合征
肿瘤溶解综合征(TLS)是一种严重的肿瘤急症,其特点是肿瘤细胞大量破裂,导致细胞内内容物迅速释放到体循环中,超过了体内平衡机制。这一过程会导致高尿酸血症(细胞内 DNA 释放的副产品)、高钾血症、高磷血症、低钙血症和黄嘌呤积累。这些电解质和代谢失衡会导致急性肾损伤、心律失常、癫痫发作、多器官功能衰竭,甚至死亡。虽然 TLS 可以自发发生,但通常在开始有效治疗后不久就会出现,尤其是在癌细胞质量较大的患者中(定义为体重≥500 克或儿童体表面积≥300 克/平方米)。为预防 TLS,必须密切监测和补充水分,以改善肾脏灌注和尿量,并尽量减少尿酸或磷酸钙在肾小管中的沉淀。干预措施基于患者发生 TLS 的风险,可包括拉嘌呤酶和别嘌醇。黄嘌呤通常会通过酶转化为尿酸,在治疗 TLS 期间使用别嘌呤醇等黄嘌呤氧化酶时,黄嘌呤会积聚。测量黄嘌呤对优化别嘌呤醇或拉斯勃酶的使用是否有临床意义仍有待确定。
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来源期刊
Nature Reviews Disease Primers
Nature Reviews Disease Primers Medicine-General Medicine
CiteScore
76.70
自引率
0.20%
发文量
75
期刊介绍: Nature Reviews Disease Primers, a part of the Nature Reviews journal portfolio, features sections on epidemiology, mechanisms, diagnosis, management, and patient quality of life. The editorial team commissions top researchers — comprising basic scientists and clinical researchers — to write the Primers, which are designed for use by early career researchers, medical students and principal investigators. Each Primer concludes with an Outlook section, highlighting future research directions. Covered medical specialties include Cardiology, Dermatology, Ear, Nose and Throat, Emergency Medicine, Endocrinology, Gastroenterology, Genetic Conditions, Gynaecology and Obstetrics, Hepatology, Haematology, Infectious Diseases, Maxillofacial and Oral Medicine, Nephrology, Neurology, Nutrition, Oncology, Ophthalmology, Orthopaedics, Psychiatry, Respiratory Medicine, Rheumatology, Sleep Medicine, and Urology.
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