ORIGINAL RESEARCH article
Front. Oncol.
Sec. Hematologic Malignancies
TUMOR LYSIS SYNDROME IN CHILDREN WITH HEMATOLOGICAL MALIGNANCIES: A NEPHROLOGY PERSPECTIVE IN RESOURCE-LIMITED SETTINGS
Samar Atef Elshafey 1
Lamiaa Essa 1
Maha Zaid 1
Yasser Wali 2
Yasmine El Chazli 1
1. Alexandria University Faculty of Medicine, Alexandria, Egypt
2. College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
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Abstract
Background: Tumor lysis syndrome (TLS) is a major metabolic emergency in pediatric oncology and a leading cause of acute kidney injury (AKI) in children with hematological malignancies. Early identification of children at risk for severe AKI remains challenging. Methods: This retrospective study included 50 children with laboratory or clinical TLS diagnosed according to the Howard–Pui classification. Serial biochemical parameters were analyzed over a 10-day period. AKI severity was classified using the pediatric Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) criteria based on changes in estimated glomerular filtration rate (eGFR). Clinical characteristics, biochemical trends (especially phosphate and uric acid), and outcomes were compared between children with mild (pRIFLE 0 [no AKI]/R/I) and severe (pRIFLE-F) AKI. Results: Twenty-seven patients had acute lymphoblastic leukemia (ALL), and 23 had lymphoma, mainly Burkitt's lymphoma. Clinical TLS accounted for 86% of cases, and 60% of children developed severe AKI. Severe AKI was significantly associated with spontaneous TLS onset, prolonged TLS duration, increased need for kidney replacement therapy, intensive care admission, and higher mortality. Static demographic characteristics, malignancy type, tumor burden, and radiological findings did not differ between AKI severity groups. While hyperphosphatemia and hyperuricemia were common, dynamic phosphate changes showed the strongest association with AKI severity. The daily rise in serum phosphate before AKI onset demonstrated good discriminatory performance for predicting severe AKI (AUC 0.839), outperforming changes in uric acid. Conclusion: In pediatric TLS, AKI severity is the main determinant of clinical outcome. Dynamic phosphate kinetics (Delta phosphorus), rather than static biochemical thresholds, represent a robust early biomarker for identifying children at risk of severe AKI and may improve risk stratification, particularly in resource-limited settings.
Summary
Keywords
Acute Kidney Injury, Febuxostat, Kidney replacement therapy, phosphate dynamics, Rasburicase, Tumor Lysis Syndrome
Received
31 December 2025
Accepted
17 February 2026
Copyright
© 2026 Elshafey, Essa, Zaid, Wali and El Chazli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yasser Wali
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