Kaysen G A, Pond S M, Roper M H, Menke D J, Marrama M A
Arch Intern Med. 1985 Nov;145(11):2019-23.
Combined hepatocellular injury and renal tubular necrosis developed in five alcoholic patients who were receiving acetaminophen therapeutically. Two patients were taking doses prescribed by a physician. The hepatitis was characterized by extremely high serum transaminase values that were maximal on admission. Two patients died, and autopsy disclosed hepatic centrizonal necrosis and acute renal tubular necrosis. The three who survived had clinical features typical of acute tubular necrosis. All five had measurable concentrations of acetaminophen in plasma, although measurements were requested on admission only in two patients. When an alcoholic presents with combined hepatic and renal insufficiency, acetaminophen should be considered as a possible inciting agent. This diagnosis should be considered when serum transaminase levels are markedly elevated and when renal failure is due to acute tubular necrosis.
五名接受对乙酰氨基酚治疗的酒精性肝病患者出现了合并肝细胞损伤和肾小管坏死。两名患者服用的是医生开的剂量。肝炎的特点是血清转氨酶值极高，入院时达到最高值。两名患者死亡，尸检显示肝小叶中心坏死和急性肾小管坏死。三名幸存者具有急性肾小管坏死的典型临床特征。所有五名患者血浆中对乙酰氨基酚浓度均可测，尽管仅两名患者入院时进行了检测。当酒精性肝病患者出现肝肾功能不全合并时，应考虑对乙酰氨基酚可能为诱发因素。当血清转氨酶水平显著升高且肾衰竭由急性肾小管坏死所致时，应考虑这一诊断。
