Frequency of renal impairment in paracetamol overdose compared with other causes of acute liver damage.

Abstract

SUMMARY In an analysis of 160 patients with fulminant hepatic failure, the frequency of renal failure in the patients who had taken an overdose of paracetamol was not significantly higher than in those with hepatic failure due to other causes. The same was found in another group of patients with less severe hepatic damage. In both the latter group and the patients with fulminant hepatic failure, the development of renal failure was closely related to the occurrence of endotoxaemia as detected by the Limulus lysate assay. These findings do not support the concept that an overdose of paracetamol has a specific nephrotoxic effect.

481 Prevalence, Severity and Impact of Renal Dysfunction in Acute Liver Failure on the U.S. Liver Transplant Waiting List

“…Our findings are consistent with other reports investigating the frequency of renal dysfunction in ALF [17][18][19][20][21] . The prevalence of renal dysfunction in patients with ALF has been previous reported to be 38% to 79% [17][18][19][20][21] .…”

“…Differences in prevalence are likely due to variable definitions used to identify renal dysfunction and differences in the population studied. Prior studies have reported association of renal dysfunction with increased mortality in ALF patients 17,19,20 , our data expand prior experience and emphasize that mortality in patients with renal dysfunction and ALF is high and that mortality increases with severity of renal dysfunction even after controlling for etiology of ALF, INR, total bilirubin and region. Our study evaluated the severity of renal dysfunction not only in APAP-induced ALF but also in several etiologies of ALF and its impact on mortality using a multivariate analysis.…”

“…The prevalence of renal dysfunction in patients with ALF has been previous reported to be 38% to 79% [17][18][19][20][21] . Differences in prevalence are likely due to variable definitions used to identify renal dysfunction and differences in the population studied.…”

“…We reported survival outcomes for two distinct time periods: 1) overall outcomes during entire time on the waiting list; and 2) all-cause mortality on the waiting list during 6 weeks after listing for ALF. A total of 91 patients were excluded from the survival analysis if their outcome on the waiting list was unknown (60), underwent living donor liver transplantation (10), transplanted at another center (multiple listing) (1), transferred to another center (1), refused liver transplant (2) or died during transplant procedure (17). To determine overall outcomes during entire time on the waiting list analysis, patients were followed from the time of listing until death, removal from the list due to improvement or deterioration, transplantation or until their last follow-up on the liver transplant waiting list.…”

Protective effect of oral ascorbic acid (vitamin c) against acetaminophen- induced hepatic injury in rats

“…The non-steroidal analgesic-antipyretic drug, acetaminophen, is one of the safest over-thecounter drugs when used in recommended doses, but is capable of producing massive hepatic necrosis on acute overdose or chronic low dose use (Prescott et al, 1971;Wilkinson et al, 1977;Bonkovsky et al, 1994). However, different treatment strategies have been proposed to ameliorate or prevent acetaminophen-induced hepatotoxicity (Mitchell et al, 1974;Bessems and Vermeulen, 2001).…”