Blakely P, McDonald B R
Division of Nephrology and Hypertension, UCSD Medical Center, La Jolla 92093-0623, USA.
J Am Soc Nephrol. 1995 Jul;6(1):48-53. doi: 10.1681/ASN.V6148.
Acetaminophen is the most commonly reported drug overdose in the United States. Acute renal failure occurs in less than 2% of all acetaminophen poisonings and 10% of severely poisoned patients. At the therapeutic dosages, acetaminophen can be toxic to the kidneys in patients who are glutathione depleted (chronic alcohol ingestion, starvation, or fasting) or who take drugs that stimulate the P-450 microsomal oxidase enzymes (anticonvulsants). Acute renal failure due to acetaminophen manifests as acute tubular necrosis (ATN). ATN can occur alone or in combination with hepatic necrosis. The azotemia of acetaminophen toxicity is typically reversible, although it may worsen over 7 to 10 days before the recovery of renal function occurs. In severe overdoses, renal failure coincides with hepatic encephalopathy and dialysis may be required. Recognition of acetaminophen nephropathy requires the following: (1) a thorough drug history, including over-the-counter medications such as Tylenol or Nyquil; (2) knowledge of the risk factors that lessen its margin of safety at therapeutic ingestions, i.e., alcoholism; and (3) consideration of acetaminophen in the differential diagnosis of patients who present with combined hepatic dysfunction and ATN.
对乙酰氨基酚是美国报告最多的药物过量案例。急性肾衰竭在所有对乙酰氨基酚中毒案例中发生率不到2%，在重度中毒患者中为10%。在治疗剂量下，对乙酰氨基酚对谷胱甘肽缺乏（长期饮酒、饥饿或禁食）的患者或服用刺激P - 450微粒体氧化酶的药物（抗惊厥药）的患者肾脏可能有毒性。对乙酰氨基酚所致的急性肾衰竭表现为急性肾小管坏死（ATN）。ATN可单独发生或与肝坏死同时出现。对乙酰氨基酚中毒导致的氮质血症通常是可逆的，尽管在肾功能恢复前的7至10天可能会恶化。在严重过量中毒时，肾衰竭与肝性脑病同时出现，可能需要进行透析。识别对乙酰氨基酚肾病需要以下几点：（1）详细的用药史，包括泰诺或奈奎尔等非处方药；（2）了解在治疗性摄入时降低其安全边际的风险因素，即酗酒；（3）在对出现肝功能不全和ATN的患者进行鉴别诊断时考虑对乙酰氨基酚。
