Tumor Lysis Syndrome (TLS) is a potentially life-threatening metabolic emergency that occurs when a large number of malignant cells break down rapidly, releasing intracellular contents into the bloodstream and overwhelming the kidneys’ capacity to maintain metabolic balance. TLS is most commonly associated with hematologic malignancies such as leukemias and lymphomas, particularly following initiation of chemotherapy, but it may also occur spontaneously in patients with high tumor burden. In the UAE, TLS is a critical consideration in oncology patients with renal vulnerability.

The pathophysiology of TLS centers on the sudden release of uric acid, potassium, and phosphate, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia. Uric acid and calcium-phosphate crystals may precipitate within renal tubules, causing obstruction, inflammation, and acute kidney injury. These metabolic derangements can rapidly progress to cardiac arrhythmias, seizures, and kidney failure if not promptly addressed.

Patients at highest risk include those with rapidly proliferating tumors, high baseline tumor burden, pre-existing kidney disease, dehydration, and elevated serum uric acid levels. Clinical manifestations may include nausea, vomiting, lethargy, muscle cramps, reduced urine output, and cardiac rhythm disturbances. In some cases, kidney injury may be the earliest sign of TLS.
Diagnosis is based on laboratory criteria demonstrating characteristic metabolic abnormalities and rising serum creatinine in the appropriate clinical context. Close monitoring is essential in high-risk patients, particularly during the first days of cancer therapy. Early detection allows timely intervention and prevention of severe complications.

Management of TLS emphasizes prevention and early treatment. Aggressive intravenous hydration is central to maintaining urine flow and reducing crystal formation. Therapies to control uric acid levels are used prophylactically or therapeutically in at-risk patients. Electrolyte abnormalities are corrected promptly, and cardiac monitoring is often required. Renal replacement therapy may be necessary in severe cases with refractory metabolic disturbances or established kidney failure.

With appropriate preventive strategies and early nephrology involvement, the incidence of severe TLS-related kidney injury can be significantly reduced. Survivors require follow-up to assess renal recovery and manage long-term kidney health, especially if underlying chronic kidney disease is present.