Acute tubular necrosis, caused by therapeutic doses of paracetamol?

Reversible acute renal failure of unknown cause occurred in two men after taking paracetamol in therapeutic doses. Tubular necrosis was present; liver function was normal. We postulate that these patients might have formed arylating metabolites of paracetamol within the kidney which bound to tubular cells causing necrosis. Such events may not be infrequent but are unrecognized because paracetamol is not regarded as nephrotoxic in standard dosage. We suggest that a detailed history in cases of acute renal failure should include direct enquiry as to the ingestion of paracetamol in order to collect information on this point.