What preventive measures are important to reduce TLS risk during cancer therapy?

• A. Aggressive hydration, uric acid–lowering therapy (allopurinol or rasburicase), electrolyte monitoring, and early recognition
• B. Limiting hydration and avoiding diuretics
• C. Delaying cancer therapy until TLS develops
• D. Relying on imaging for early recognition only

Answer: (A)

Preventing tumor lysis syndrome during cancer therapy centers on proactive measures that protect the kidneys and prevent metabolic chaos. Aggressive IV hydration keeps the kidneys well perfused and helps flush out uric acid and electrolytes released from shattered tumor cells, reducing the risk of uric acid nephropathy and acute kidney injury. Uric acid–lowering therapy, using allopurinol to reduce uric acid production or rasburicase to rapidly lower existing uric acid, is crucial for preventing crystal formation and renal injury, especially in high-risk patients. Close electrolyte and kidney function monitoring allows early detection of dangerous shifts—hyperkalemia, hyperphosphatemia, hypocalcemia—and enables timely interventions before clinical complications develop. Early recognition of TLS signs facilitates rapid management to stop progression and protect organ function.

Limiting hydration or avoiding diuretics would undermine kidney protection. Delaying cancer therapy until TLS appears is unsafe and not a preventive strategy. Relying on imaging alone for early detection misses the critical metabolic changes that occur with TLS.