Aetiology

• chemotherapy
• steroids
• biological immunomodulators (thalidomide, zoledronic acid)
• spontaneous

Risk Factors

• leukemia with very high WBCs
• high grade lymphomas
• hepatoblastoma
• neuroblastoma

Pathophysiology

• Chemo → lysis of tumour cells → massive release of intracellular ions (K+, PO4, urate)
  • AKI: metabolized to (pro inflammatory) uric acid → kidney → uric acid obstructive uropathy → acute kidney injury
  • Hyperkalemia: Obstructive uropathy from uric acid salt can limit the excretion of potassium → arrhythmia/cardiac arrest
  • Hyperphosphataemia: decreased PO4 renal excretion → increased PO4 → chleation of Ca2+ and deposition into kidney and soft tissue
  • Hypocalcemia: increased PO4 → chelated Ca2+ → arrhythmia, tetany, seizure, death

Clinical features

• signs of primary tumour
• signs of uraemia
• signs of AKI