Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirteen patients met our criteria for severe acetaminophen hepatotoxicity over a 5-year study period. Six patients had therapeutic misadventures (not attempting suicide), and seven were attempting suicide. Five of six patients in the therapeutic misadventure group were chronic alcoholics, and three were taking other drugs reported to cause hepatic microsomal enzyme induction. In the suicide group, two of seven patients were alcoholics, and one patient was taking another inducing drug. All six patients in the therapeutic misadventure group had nausea, vomiting, or starvation, whereas two of seven patients in the suicide group had similar characteristics. Starvation could deplete the protective factor glutathione, thus augmenting hepatotoxicity. In the therapeutic misadventure group, four of six patients developed acute tubular necrosis, as compared to two of seven in the suicide group. One patient died in each group. Clinicians should be aware of these features as part of the spectrum of acetaminophen toxicity.
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PMID:Clinical features of acetaminophen toxicity. 335 89

Phosphatidylcholine, the most abundant phospholipid in renal cellular membranes, is synthesized predominantly via the Kennedy pathway in normal and growing kidney tissue. Augmented biosynthesis of phosphatidylcholine is one of the earliest responses to growth signals in renal cells. During potassium depletion, regeneration after acute tubular necrosis, and compensatory growth after uninephrectomy increased membrane phosphatidylcholine biosynthesis precedes the appearance of new organelles and surface structures and the onset of cell division. The increment in phosphatidylcholine biosynthesis in the growing kidneys of potassium-depleted rats appears to be mediated by enhanced cellular uptake of the precursor choline and activation of the enzyme cytidine diphosphocholine:1,2-diacylglycerol cholinephosphotransferase. Specific amino acids, cations, and polyamines can modify the activity of this microsomal enzyme in normal and growing renal cells. Phospholipase A also plays a regulatory role in phosphatidylcholine metabolism because inhibition of this catabolic enzyme favors phospholipid accretion and kidney growth during potassium depletion, whereas stimulation of the enzyme leads to brisk phospholipid breakdown and a decrease in tissue mass during potassium repletion.
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PMID:Phosphatidylcholine metabolism during renal growth and regeneration. 636 86

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.
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PMID:Acute renal failure due to acetaminophen ingestion: a case report and review of the literature. 757 69