Tumor lysis syndrome prevention includes which of the following measures?

• A. Dehydration and diuretics
• B. Hydration and administration of allopurinol
• C. Increased purine diet
• D. No hydration required

Answer: (B)

Preventing tumor lysis syndrome focuses on keeping the kidneys well perfused and lowering the amount of uric acid the kidneys have to handle. When tumor cells lyse, their nucleic acids become uric acid, which can crystallize in the renal tubules and cause acute kidney injury. Aggressive IV hydration maintains high urine flow, dilutes uric acid, and helps flush it out, reducing crystal formation. Allopurinol inhibits xanthine oxidase, decreasing conversion of purines into uric acid, so less uric acid is produced to burden the kidneys. Dehydration or relying on a high-purine diet would worsen uric acid burden and impair clearance, and no hydration would miss the essential kidney-protective step. In some high-risk cases, rasburicase can be used to rapidly degrade uric acid, but hydration plus allopurinol is a foundational prevention approach.