Kianoush Saberi
1 
, Shima Mohammadkhani
2 , Zahed Karimi
3 , Elham Kebriyaei
4 , Mohammad Reza Farnia
5 , Kamran Safa
6 , Sara Ghaseminejad Kermani
6 , Amirhossein Salimi Mansouri
7 , Naeem Nikpour
8* 1 Department of Anesthesiology, Medical Faculty, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Emergency Medicine, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
3 Department of Internal Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
4 Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran
5 Department of Emergency Medicine, Taleghani and Imam Reza hospitals, School of Medicine, Kermanshah University of Medical Science, Kermanshah, Iran
6 Department of Emergency Medicine, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
7 Research Center for Chronic Inflammatory Diseases, Tehran University of Medical Sciences, Tehran, Iran
8 Department of Hematology and Medical Oncology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Tumor lysis syndrome (TLS) represents a critical oncologic emergency wherein rapid cellular breakdown precipitates metabolic derangements and frequently culminates in acute kidney injury (AKI). Despite established guidelines, delayed recognition and inconsistent initial management in emergency departments contribute to preventable morbidity. Emergency physician–directed risk stratification facilitated earlier identification of patients requiring aggressive prophylaxis or escalation, while protocol adherence minimized therapeutic delays and practice variability across high-acuity presentations. These findings demonstrate that structured, emergency department–initiated TLS pathways substantially improve renal and clinical outcomes by translating guideline recommendations into actionable frontline workflows. Integrating such standardized, physician-led algorithms into routine oncologic emergency care is both feasible and impactful, warranting broader institutional adoption and prospective validation across diverse healthcare settings.
Implication for health policy/practice/research/medical education:
Tumor lysis syndrome (TLS) is a time‑critical oncologic emergency in which rapid tumor cell breakdown leads to severe metabolic disturbances and a high risk of acute kidney injury (AKI). The literature review highlights that, despite the existence of guidelines, delayed recognition and variable early management in emergency departments still drive avoidable morbidity. It emphasizes that structured, emergency physician–led risk stratification and protocolized care can enable earlier identification of high‑risk patients, more timely prophylaxis and treatment, and reduced practice variability. Overall, the key message is that implementing standardized, emergency department–initiated TLS pathways is feasible, improves renal and clinical outcomes, and should be more widely adopted and prospectively validated in diverse healthcare settings.
Please cite this paper as: Saberi K, Mohammadkhani Sh, Karimi Z, Kebriyaei E, Farnia MR, Safa K, Ghaseminejad Kermani S, Salimi Mansouri A, Nikpour N. Early risk stratification and protocol-driven management of tumor lysis syndrome–associated acute kidney injury; impact of emergency physician–led interventions in the emergency department. J Renal Inj Prev. 2026; x(x): e38773. doi: 10.34172/jrip.38773.