Possible Interaction: Acetylcysteine and Creatinine

“An increase of at … mg/dl of the creatinine concentration 48 h after the procedure occurred … 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (….019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85).”

“ Acetylcysteine treatment significantly increased creatinine clearance from 44.8 mL/min (0.75 mL/s) (95% CI, 42.7-47.6 mL/min) to 58.9 mL/min (0.98 mL/s) (95% CI, 55.6-62.3 mL/min) 2 days after the contrast administration (P<.001).”

“Evidence for relatively minor inhibition of Cr was observed in patients after NAC administration.”

“A 25% or greater increase in systemic creatinine concentration was found in nine of 43 patients in the control group and in two of 44 patients in the NAC group (p = 0.026).”

“Thus, it may be that NAC has a direct effect on the systemic creatinine concentration, whereas it has no effect on preventing contrast-induced nephrotoxicity [6, 7].”

“Measurements and Main Results:Patients who received N-acetylcysteine had an incidence of acute renal failure (≥0.5 mg/dL increase in creatinine ) of 15.5%, compared with 16.9% in those receiving placebo (p = .82, not significant).”

“It was noted that there was not only a protective effect of the drug but an actual decrease in the mean creatinine in the patients who received acetylcysteine.”

“Following treatment with NAC, creatinine clearance increased to 43 (4) mL/min (p<0·001), and serum creatinine decreased to 169 (7) mmol/L (p=<0·02) by day 5 (figure A).”

“Post-treatment with NAC diminished the decrease in MAP, increased the HR, and decreased the markers of organ injury (BUN, Cre , LDH, CPK, GOT, GPT) and inflammatory biomarkers (TNF-alpha, IL-6, IL-10) after LPS.”

“ NAC pretreatment significantly attenuates the effects of endotoxin on BUN, creatinine and TNF-a levels in cirrhotic rats with no improvement in systemic toxicity symptoms.”

“However, there was a significant decline in creatinine level among NAC patients (P = 0.001).”