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TLS AKI Prevention — RACP Adult Medicine MCQ

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HardNephrologyTLS AKI PreventionRACP Adult Medicine

A 55-year-old with high-burden AML is about to start cytotoxic therapy. Uric acid is already elevated, kidney function is normal and the tumour-lysis risk is high. Which prophylaxis is most appropriate?

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Correct answer: A — Begin vigorous monitored hydration and rasburicase, with frequent electrolyte, urate and kidney-function measurements

The best answer is “Begin vigorous monitored hydration and rasburicase, with frequent electrolyte, urate and kidney-function measurements”. High-risk tumour lysis requires hydration plus rapid urate reduction with rasburicase and close biochemical monitoring. Allopurinol prevents formation of new uric acid but does not rapidly clear an already elevated burden. Routine alkalinisation can promote calcium-phosphate precipitation, dialysis is reserved for established indications, and fluid restriction worsens crystal-related kidney risk unless a specific contraindication exists.

Reference: Kidney Health Australia: CKD Management in Primary Care, 5th edition: https://kidney.org.au/health-professionals/ckd-management-handbook/