Tumor Lysis Syndrome Differential Diagnoses

  • Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Jules E Harris, MD   more...
 
Updated: May 16, 2012
 
 

Diagnostic Considerations

Patients with cancer are at increased risk of renal failure from etiologies other than tumor lysis syndrome.[21] Prerenal causes include volume depletion from anorexia, vomiting, diarrhea, and bleeding. Pelvic or retroperitoneal masses can lead to kidney failure from postrenal urinary tract obstruction.

Renal parenchymal disorders include the following:

  • Tumor infiltration
  • Myeloma kidney
  • Drug nephrotoxicity from chemotherapeutic agents or antibiotics
  • Radiocontrast nephropathy
  • Vasculitis
  • Cryoglobulinemic glomerulonephritis

The combination of volume depletion, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia strongly support the diagnosis of tumor lysis syndrome over other causes.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Koyamangalath Krishnan, MD, FRCP, FACP  Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Devapiran Jaishankar, MBBS  Associate Professor, Division of Oncology, East Tennessee State University, James H Quillen College of Medicine

Devapiran Jaishankar, MBBS is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

Steven K Bergstrom, MD Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology

Disclosure: Nothing to disclose.

Max J Coppes, MD, PhD, MBA Senior Vice President, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University School of Medicine; Clinical Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Stephan A Grupp, MD, PhD Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Alan K Ikeda, MD Assistant Professor, Department of Pediatrics, Division of Hematology and Oncology, David Geffen School of Medicine at UCLA; Associate Director of Pediatric Blood and Marrow Transplantation, Mattel Children's Hospital

Alan K Ikeda, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Blood and Marrow Transplantation, and American Society of Pediatric Hematology/Oncology

Disclosure: emedicine Honoraria author

Koyamangalath Krishnan, MD, FRCP, FACP Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians

Disclosure: Nothing to disclose.

Kathleen M Sakamoto, MD, PhD Professor and Chief, Division of Hematology-Oncology, Vice-Chair of Research, Mattel Children's Hospital at UCLA; Co-Associate Program Director of the Signal Transduction Program Area, Jonsson Comprehensive Cancer Center, California Nanosystems Institute and Molecular Biology Institute, University of California, Los Angeles, David Geffen School of Medicine

Kathleen M Sakamoto, MD, PhD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, International Society for Experimental Hematology, Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Amit P Sarnaik, MD Staff Physician, Department of Pediatrics, Wayne State University and Children's Hospital of Michigan

Amit P Sarnaik, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Clinical Professor, Department of Medicine, New York University School of Medicine

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Bishop MR, Cairo MS, Coccia PF. Tumor lysis syndrome. In: Abeloff MD, ed. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:50.

  2. Flombaum CD. Metabolic emergencies in the cancer patient. Semin Oncol. Jun 2000;27(3):322-34. [Medline].

  3. King JE. What is tumor lysis syndrome?. Nursing. May 2008;38(5):18. [Medline].

  4. Jagasia MH, Arrowsmith ER. Complications of hematopoietic neoplasms. In: Wintrobe MM, Greer JP, Foerster J, et al. Wintrobe's Clinical Hematology. Vol II. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1919-44.

  5. Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin's lymphoma. Am J Med. Feb 1993;94(2):133-9. [Medline].

  6. Cohen LF, Balow JE, Magrath IT, et al. Acute tumor lysis syndrome. A review of 37 patients with Burkitt's lymphoma. Am J Med. Apr 1980;68(4):486-91. [Medline].

  7. Ezzone SA. Tumor lysis syndrome. Semin Oncol Nurs. Aug 1999;15(3):202-8. [Medline].

  8. Fleming DR, Doukas MA. Acute tumor lysis syndrome in hematologic malignancies. Leuk Lymphoma. Nov 1992;8(4-5):315-8. [Medline].

  9. Kalemkerian GP, Darwish B, Varterasian ML. Tumor lysis syndrome in small cell carcinoma and other solid tumors. Am J Med. Nov 1997;103(5):363-7. [Medline].

  10. Kelly KM, Lange B. Oncologic emergencies. Pediatr Clin North Am. Aug 1997;44(4):809-30. [Medline].

  11. Klinenberg JR, Kippen I, Bluestone R. Hyperuricemic nephropathy: pathologic features and factors influencing urate deposition. Nephron. 1975;14(1):88-98. [Medline].

  12. Arrambide K, Toto RD. Tumor lysis syndrome. Semin Nephrol. May 1993;13(3):273-80. [Medline].

  13. Abu-Alfa AK, Younes A. Tumor lysis syndrome and acute kidney injury: evaluation, prevention, and management. Am J Kidney Dis. May 2010;55(5 Suppl 3):S1-13; quiz S14-9. [Medline].

  14. Obrador GT, Price B, O'Meara Y, et al. Acute renal failure due to lymphomatous infiltration of the kidneys. J Am Soc Nephrol. Aug 1997;8(8):1348-54. [Medline].

  15. Chen SW, Hwang WS, Tsao CJ, et al. Hydroxyurea and splenic irradiation-induced tumour lysis syndrome: a case report and review of the literature. J Clin Pharm Ther. Dec 2005;30(6):623-5. [Medline].

  16. Lee CC, Wu YH, Chung SH, et al. Acute tumor lysis syndrome after thalidomide therapy in advanced hepatocellular carcinoma. Oncologist. Jan 2006;11(1):87-8; author reply 89. [Medline].

  17. Jaskiewicz AD, Herrington JD, Wong L. Tumor lysis syndrome after bortezomib therapy for plasma cell leukemia. Pharmacotherapy. Dec 2005;25(12):1820-5. [Medline].

  18. Kurt M, Onal IK, Elkiran T, et al. Acute tumor lysis syndrome triggered by zoledronic Acid in a patient with metastatic lung adenocarcinoma. Med Oncol. 2005;22(2):203-6. [Medline].

  19. Leibowitz AB, Adamsky C, Gabrilove J, Labow DM. Intraoperative acute tumor lysis syndrome during laparoscopic splenectomy preceded by splenic artery embolization. Surg Laparosc Endosc Percutan Tech. Jun 2007;17(3):210-1. [Medline].

  20. Mughal TI, Ejaz AA, Foringer JR, Coiffier B. An integrated clinical approach for the identification, prevention, and treatment of tumor lysis syndrome. Cancer Treat Rev. Apr 2010;36(2):164-76. [Medline].

  21. Lazarus JM, Brenner BM. Chronic renal failure. In: Fauci SA, ed. Harrison's Principles of Internal Medicine. Vol 2. 14th ed. New York, NY: McGraw Hill; 1998:1513-20.

  22. Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. Jun 1 2008;26(16):2767-78. [Medline].

  23. Del Toro G, Morris E, Cairo MS. Tumor lysis syndrome: pathophysiology, definition, and alternative treatment approaches. Clin Adv Hematol Oncol. Jan 2005;3(1):54-61. [Medline].

  24. Jones DP, Mahmoud H, Chesney RW. Tumor lysis syndrome: pathogenesis and management. Pediatr Nephrol. Apr 1995;9(2):206-12. [Medline].

  25. Rohaly-Davis J, Johnston K. Hematologic emergencies in the intensive care unit. Crit Care Nurs Q. Feb 1996;18(4):35-43. [Medline].

  26. Mahmoud HH, Leverger G, Patte C, et al. Advances in the management of malignancy-associated hyperuricaemia. Br J Cancer. Jun 1998;77 Suppl 4:18-20. [Medline].

  27. Yim BT, Sims-McCallum RP, Chong PH. Rasburicase for the treatment and prevention of hyperuricemia. Ann Pharmacother. Jul-Aug 2003;37(7-8):1047-54. [Medline].

  28. Bessmertny O, Robitaille LM, Cairo MS. Rasburicase: a new approach for preventing and/or treating tumor lysis syndrome. Curr Pharm Des. 2005;11(32):4177-85. [Medline].

  29. Goldman SC. Rasburicase: potential role in managing tumor lysis in patients with hematological malignancies. Expert Rev Anticancer Ther. Aug 2003;3(4):429-33. [Medline].

  30. Jeha S, Pui CH. Recombinant urate oxidase (rasburicase) in the prophylaxis and treatment of tumor lysis syndrome. Contrib Nephrol. 2005;147:69-79. [Medline].

  31. Browning LA, Kruse JA. Hemolysis and methemoglobinemia secondary to rasburicase administration. Ann Pharmacother. Nov 2005;39(11):1932-5. [Medline].

  32. Kizer N, Martinez E, Powell M. Report of two cases of rasburicase-induced methemoglobinemia. Leuk Lymphoma. Dec 2006;47(12):2648-50. [Medline].

  33. Andreoli SP, Clark JH, McGuire WA, Bergstein JM. Purine excretion during tumor lysis in children with acute lymphocytic leukemia receiving allopurinol: relationship to acute renal failure. J Pediatr. Aug 1986;109(2):292-8. [Medline].

  34. Lorigan PC, Woodings PL, Morgenstern GR, et al. Tumour lysis syndrome, case report and review of the literature. Ann Oncol. Aug 1996;7(6):631-6. [Medline].

 
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