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

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