Nickan Research Institute Journal of Renal Injury Prevention 2345-2781 15 4 2026 12 01 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 e38773 e38773 10.34172/jrip.38773 EN Kianoush Saberi https://orcid.org/0000-0002-4292-2252 Shima Mohammadkhani https://orcid.org/0009-0005-4686-7931 Zahed Karimi https://orcid.org/0000-0002-2304-6779 Elham Kebriyaei https://orcid.org/0009-0002-4557-7412 Mohammad Reza Farnia https://orcid.org/0000-0002-4397-8661 Kamran Safa https://orcid.org/0000-0002-3630-5418 Sara Ghaseminejad Kermani https://orcid.org/0000-0002-1730-8437 Amirhossein Salimi Mansouri https://orcid.org/0009-0009-1486-361X Naeem Nikpour https://orcid.org/0000-0002-4265-5430 Journal Article 10.34172/jrip.38773 2026 03 17 2026 06 05 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.