A small percentage of patients who experience an overdose of acetaminophen develop a nephrotoxicity that is usually reversible.
Mechanism: cytochrome P450 releases metabolites that react with glutathione and sulfhydryl groups in the proximal tubule
Most patients with acetaminophen-induced nephrotoxicity have hepatotoxicity.
Clinical and laboratory features (Boutis and Shannon):
(1) serum creatinine > 1.1 mg/dL and elevated BUN
(2) hypertension (systolic blood pressure > 140 mm Hg, diastolic > 85 mm Hg)
(3) hematuria and/or proteinura
Risk factors for nephrotoxicity:
(1) adolescent or young adult
(2) depleted glutathione levels (starvation, fasting, alcoholism, etc)
(3) medications that induce the P450 enzyme system
