This protocol addresses patients with confirmed established tumour lysis syndrome — whether defined by laboratory criteria or clinical presentation — in whom the initial treatment approach has not achieved the required urine output target.
Established TLS encompasses both laboratory TLS (metabolic abnormalities without end-organ involvement) and clinical TLS (with acute kidney injury, cardiac arrhythmia, or seizure). This protocol applies when patients present with or progress to the established form of the syndrome requiring escalated intervention.
Initial management — including vigorous intravenous hydration, rasburicase, and electrolyte correction — aims to maintain a urine output of 100 mL/m²/h in adults. When this urine output target is not met, or when hyperphosphataemia and hyperkalaemia prove refractory to medical treatment, further escalation is required.
This protocol represents the next step for patients who have not responded adequately to the measures above.
Kidney replacement therapy (KRT) is involved in the management of refractory cases. The approach and setting of KRT are guided by the patient's clinical status — the full protocol details which patients require which form of renal support and under what circumstances it should be initiated.