Acetaminophen-Induced Renal Failure - An Overview

Introduction:

Acetaminophen is used to relieve mild-to-moderate pain caused by headaches, muscle aches, menstrual bleeding, colds, sore throats, toothaches, back pain, post-vaccination fever, and pain. Acetaminophen belongs to the class of medications called analgesics and antipyretics and is sold over-the-counter. It works by stopping the prostaglandin enzyme production in the brain, this further blocks the transmission of pain in the nerves. In renal failure, the kidneys lose their filtering ability, high amounts of waste accumulates, and the blood’s chemical makeup goes out of balance. As a result, acute kidney failure develops rapidly, otherwise known as acute renal failure or acute kidney injury.

What Is Acetaminophen-Induced Renal Failure?

Acetaminophen is one of the most commonly used and available analgesics and antipyretics worldwide and is easily available as it has fewer side effects than other analgesics or antipyretics. However, an overdose of Acetaminophen can cause severe and fatal liver and renal toxicity and damage when taken in high quantities or regularly over a long time. The maximum daily dose of Acetaminophen is 4.0 g, and overdoses of 7.5 g to 10.0 g can cause hepatotoxicity and nephrotoxicity.

At the normal therapeutic dosages, Acetaminophen can be toxic for the kidneys in patients with glutathione depletion in the body (chronic alcohol ingestion, starvation, or fasting) or who take drugs that stimulate the P-450 microsomal oxidase enzymes (anticonvulsants).

Causes of Acetaminophen-Induced Renal Failure

Acute tubular necrosis is a potential mechanism of renal failure associated with Acetaminophen use. Overdose or prolonged use of Acetaminophen triggers lipid peroxidation (chain of reactions of oxidative degradation of lipids), and that causes cell apoptosis, otherwise known as programmed cell death. Cell death leads to tissue necrosis (irreversible tissue death) and organ dysfunction.

What Are the Risk Factors of Acetaminophen-Induced Renal Failure?

Patient-related risk factors for drug-induced nephrotoxicity include:

• Age: People over 60 may be prone to Acetaminophen-induced nephrotoxicity.

• Underlying Renal Dysfunction: People with renal impairment and reduced glomerular filtration rate (less than 60 milliliters per minute per 1.73 square meter).

• Dehydration: When there is a loss of the body’s water content, ingestion of Acetaminophen in such cases may cause possible renal failure.

• Diabetes: People with diabetes are at an increased risk of having Acetaminophen-induced renal failure.

• Heart Disease: People with heart conditions have an elevated risk of getting Acetaminophen-induced renal failure.

• Infection in the Body: People having an infection in the body can be more prone to Acetaminophen-induced renal failure.

What Are the Symptoms of Acetaminophen-Induced Renal Failure?

The signs and symptoms of Acetaminophen-Induced renal failure include:

• Decreased urine output.

• Fluid retention causes swelling in the legs, feet, or ankles.

• Shortness of breath.

• Nausea.

• Fatigue.

• Weakness.

• Confusion.

• Irregular heartbeat.

• Chest pain or pressure.

• Coma or seizures in severe cases.

In some cases, renal failure shows no signs and symptoms and may be an incidental finding during routine tests.

What Are the Possible Complications of Acetaminophen-Induced Renal Failure?

The possible complications of Acetaminophen-induced renal failure are:

• Fluid Accumulation: Acute renal failure can cause fluid to accumulate in the lungs, causing shortness of breath.

• Chest Pain: Inflammation of the pericardium, a membrane that covers the heart, causing chest pain.

• Weakness: An imbalance in the body’s water and electrolytes (blood chemistry) can lead to muscle weakness.

• Permanent Kidney Damage: In some cases, acute renal failure can result in permanent loss of renal function or end-stage renal disease. Patients with the end-stage renal disease require either permanent dialysis (a mechanical filtration process done to remove all waste products and toxins from the body) or a kidney transplant to survive.

• Death: Acute renal failure can cause loss of kidney function and eventual death.

When to Get Help for Acetaminophen-Induced Renal Failure?

An emergency medical opinion should be sought if the following symptoms are noticed after using Acetaminophen:

• Nausea.

• Vomiting.

• Loss of appetite.

• Weakness and lethargy.

• Difficulty sleeping.

• Urinating more or less.

• Decreased mental alertness.

• Muscle cramps.

• Swelling of feet and ankles.

• Dry and itchy skin.

• High blood pressure (hypertension) that’s hard to control.

• Shortness of breath because of accumulation of fluids in the lungs.

• Chest pain due to fluid buildup around the heart’s lining.

How Is Acetaminophen-Induced Renal Failure Diagnosed?

Acetaminophen-induced renal failure is diagnosed in the following ways:

• Urine Volume Measurement - Measuring urine output over 24 hours can help doctors identify the cause of renal failure.

• Urinalysis - Analysis of a urine sample may reveal abnormalities that indicate renal failure.

• Blood Test - Blood tests may show rapidly elevated urea and creatinine levels, which indicate renal function.

• Imaging Test - Imaging tests like computed tomography scans (CT scans) and ultrasounds help doctors visualize the kidneys.

• A Sample of Kidney Tissue Is Taken for Testing - In some circumstances, doctors may recommend a kidney biopsy and obtain a small sample of kidney tissue for laboratory tests. A doctor inserts a needle via the skin into the kidney to take a sample.

How Is Acetaminophen-Induced Renal Failure Treated?

The following methods of treatment for Acetaminophen-induced renal failure:

1. Treatment in case of initial renal impairment:

• Stopping Drugs Inducing Nephrotoxicity - The drugs prescribed and causing insult to the kidney are immediately stopped.

• Starting a Low-Protein Diet - A low-protein diet to minimize waste products in the blood is started. When the body processes protein from food, it creates waste products that the kidneys filter from the blood. Physicians advise having a low intake of protein. A dietician can be consulted for the same.

• Drugs for Relieving Swelling - People with chronic kidney disease often retain fluid. The fluid retention leads to swollen legs and high blood pressure. Medications called diuretics, also known as water pills, help maintain the water balance in the body.

2. For treatment of end-stage renal failure:

• Dialysis: Dialysis artificially removes all the waste products and excess water from the blood when the kidneys fail. In hemodialysis, a machine filters excess water and waste from the blood.

• Kidney Transplant: After a transplant, medicines must be taken for the rest of the life to keep the body from rejecting the new organ. Dialysis is not required after a kidney transplant.

How to Prevent Acetaminophen-Induced Renal Failure?

• When taking over-the-counter (OTC) pain relievers, attention should be paid to the label. Directions should be followed for OTC pain relievers such as Aspirin, Acetaminophen, Ibuprofen, and Naproxen sodium. Excessive use of these drugs may increase the risk of kidney damage. It is especially true if a person already has diabetes, kidney disease, or high blood pressure.

• Doctors’ should be consulted to manage renal and other chronic diseases. Individuals with diabetes or high blood pressure should strictly adhere to the doctor’s recommendations and manage the conditions by following the doctor’s advice.

• A healthy and active lifestyle should be a priority. A sensible and balanced diet should be followed.

• Intake of alcohol should be in moderation.

Conclusion:

Acetaminophen is associated with a significantly increased risk of developing renal dysfunction in adults. Since it is an over-the-counter drug, its unchecked usage may lead to its abuse and ill effects among people unaware of its ill effects. All kinds of medications should be taken under the guidance of a registered practitioner.