29th December 2024

Presentation of TLS


Hyperuricaemia	Nucleic acids within rapidly dividing cancer cells are metabolised to insoluble uric acid	Deposition within renal tubules results in uric acid nephropathy (oliguric AKI)
Hyperphosphataemia	Cancer cells have higher PO4 levels than normal tissues. Intracellular phosphate is released into bloodstream. Can precipitate with calcium and deposit as calcium phosphate in tissues	Deposits in renal tubules cause AKI Deposits in skin can cause gangrene Deposits in the heart can cause arrhythmias
Hyperkalaemia	Intracellular potassium is released by cell breakdown, and worsened in concurrent TLS-driven AKI	Most dangerous electrolyte abnormality; can cause cardiac arrhythmias and sudden cardiac death
Hypocalcaemia (and hypomagnesaemia)	Calcium precipitates with phosphate as calcium phosphate and is depleted	Neuromuscular irritability; paraesthesias, muscle twitching, tetany, Trousseau’s sign, Chvostek’s sign, laryngospasm, bronchospasm Hypotension Cardiac failure
AKI/renal failure	May be due to precipitation of uric acid crystals or calcium phosphate within renal tubules	Creatinine rise, oliguria, symptoms of uraemia (itch, nausea, vomiting, confusion, coma)
Metabolic acidosis	Related to declining renal function; acidosis then promotes uric acid crystallisation and can, in turn, worsen AKI	Nausea, vomiting, fatigue Raised respiratory rate

Complete Guide to Clinical Genetics ST3 Application and Recruitment (2027)

Written by Medibuddy. Last updated: October 2026. Clinical Genetics is

Recruitment paused: NHS England is not running Clinical Radiology ST3+ recru

Written by Medibuddy. Last updated: October 2026. If you’re planning

Our mobile app allows you to access your interview and exam question banks wherever you are.