Florkowski C M, Jones A F, Guy J M, Husband D J, Stevens J
West Midlands Poisons Unit, Dudley Road Hospital, Birmingham, UK.
Ann Clin Biochem. 1994 Jul;31 ( Pt 4):331-4. doi: 10.1177/000456329403100404.
The occurrence of hypophosphataemia in paracetamol overdose suggests that nephrotoxicity is common, impaired renal tubular reabsorption of phosphate indicating renal damage. To investigate the potential nephrotoxicity of paracetamol, we studied 148 consecutive patients with paracetamol overdose. Serial clinical and biochemical measurements were made, and a fasting overnight urine collection was obtained for creatinine (Cr), phosphate and retinol-binding protein (RBP) determination. Renal threshold phosphate concentration (TmPO4/GFR) was determined from urinary parameters by an established nomogram. The degree of hypophosphataemia correlated with the severity of overdose, and with TmPO4/GFR. The median RBP/Cr ratio was higher in those patients exhibiting biochemical hepatotoxicity compared with those without hepatotoxicity, in whom median RBP/Cr was not significantly higher than controls. Within the group of patients showing biochemical hepatotoxicity, there was a correlation between log RBP/Cr and TmPO4/GFR. RBP/Cr ratio is a less sensitive marker of renal tubular toxicity than phosphaturia in these patients, and may indicate a different mechanism of toxicity.
对乙酰氨基酚过量时出现低磷血症提示肾毒性常见，肾小管对磷的重吸收受损表明存在肾损伤。为研究对乙酰氨基酚的潜在肾毒性，我们对148例连续的对乙酰氨基酚过量患者进行了研究。进行了系列临床和生化测量，并收集过夜空腹尿以测定肌酐（Cr）、磷和视黄醇结合蛋白（RBP）。通过既定的列线图根据尿液参数确定肾阈值磷浓度（TmPO4/GFR）。低磷血症的程度与过量的严重程度以及TmPO4/GFR相关。与无肝毒性的患者相比，出现生化肝毒性的患者中RBP/Cr比值中位数更高，而无肝毒性患者的RBP/Cr中位数并不显著高于对照组。在表现出生化肝毒性的患者组中，log RBP/Cr与TmPO4/GFR之间存在相关性。在这些患者中，RBP/Cr比值作为肾小管毒性标志物的敏感性低于磷尿，且可能提示不同的毒性机制。
