Case explanation and follow up
Our patient received a chemotherapy agent for a high grade lymphoma malignancy and soon after that he faced anuria, creatinine rise and severe diarrhea.
Our presumption is that bendamustin as the chemotherapy agent caused diarrhea and exacerbated the renal function due to pre-renal azotemia. Hence, do NOT forget tumor lysis syndrome in these patients (laboratory abnormality within 3 days prior and 7 days after chemotherapy).

The patient had hyperuricemia, hyperphosphatemia and more than 25% decrease in serum calcium level (10.8>>7.9)
He had also renal failure (which is clinical sequel for TLS)
So we have to start prophylaxis and treatment for TLS as soon as possible.
As mentioned in the algorithms, hydration and rasburicase are the mainstay treatment of TLS for high risk malignancies.
but (based on Up-to-date) in cases with

●Severe oliguria or anuria

●Intractable fluid overload

●Persistent hyperkalemia

●Hyperphosphatemia-induced symptomatic hypocalcemia

●A calcium-phosphate product ≥70 mg2/dL2

And based on Harrison 2022 in cases with
✓ Serum K+ >6.0 meq/L
✓ Serum uric acid >10 mg/dL
✓ Serum creatinine >10 mg/dL
✓ Serum phosphate >10 mg/dL or
✓ increasing Symptomatic hypocalcemia present

We should start renal replacement therapy (hemodialysis)

So our patient went on hemodialysis for 6 consecutive daily sessions. Adequate hydration and diuretic was resumed.