肿瘤溶解综合症（TLS）及其最严重的并发症急性肾损伤（AKI）是肿瘤血液学中的急症之一。预测肾损伤程度十分困难。因此，我们从肾脏病学角度回顾性研究了四个匈牙利三级中心（住院大学诊所）治疗白血病和淋巴瘤的儿童的数据（2006-2016年）。从电子和纸质医学记录中获取31名儿童患者的身体状况、实验室检验结果、治疗和疗效。患者根据“传统”的TLS分组和基于pRIFLE分级的肾脏学分类分析，如轻度或重度AKI。在两种分类中，磷酸盐稳态和尿素水平的变化存在显著差异。与年龄特定的正常磷酸盐范围相比，在TLS发展之前，低磷血症很常见（19/31个病例），而在TLS后期，高磷血症最常见（26/31个病例）。严重TLS-AKI的ROC分析显示，AKI之前日均血清磷水平的计算截点值为0.32毫摩尔/升。8名患者的24小时尿液分析数据仅显示在血清磷酸盐水平平行升高的TLS患者中短暂地增加了磷酸盐排泄。日均血清磷水平的增加可以作为儿童TLS严重程度的预测因素，也可以预测肾损伤的严重程度。图表摘要的高分辨率版本作为补充信息可供使用。©2023年作者。

Tumor lysis syndrome (TLS) and its most serious complication, acute kidney injury (AKI) are one of the emergency conditions in onco-hematology. It is difficult to predict the degree of kidney involvement. Therefore, we studied children with leukemia and lymphoma treated in four Hungarian tertiary centers (inpatient university clinics) retrospectively (2006-2016) from a nephrological aspect.Data of 31 pediatric patients were obtained from electronic- and paper-based medical records. Physical status, laboratory test results, treatments, and outcomes were assessed. Patients were analyzed according to both "traditional" TLS groupings, as laboratory TLS or clinical TLS, and nephrological aspect based on pRIFLE classification, as mild or severe AKI.Significant differences were found between the changes in parameters of phosphate homeostasis and urea levels in both classifications. Compared to age-specific normal phosphate ranges, before the development of TLS, hypophosphatemia was common (19/31 cases), while in the post-TLS period, hyperphosphatemia was observed (26/31 cases) most frequently. The rate of daily change in serum phosphate level was significant in the nephrological subgroups, but peaks of serum phosphate level show only a moderate increase. The calculated cut-off value of daily serum phosphate level increased before AKI was 0.32 mmol/L per ROC analysis for severe TLS-AKI. The 24-h urinalysis data of eight patients revealed transiently increased phosphate excretion only in those patients with TLS in whom serum phosphate was elevated in parallel.Daily serum phosphate level increase can serve as a prognostic factor for the severity of pediatric TLS, as well as predict the severity of kidney involvement. A higher resolution version of the Graphical abstract is available as Supplementary information.© 2023. The Author(s).