Protective effect of probiotics against acetaminophen induced nephrotoxicity

Acetaminophen (APAP) is commonly prescribed as an antipyretic and analgesic agent in the practical field. Like every other drug(s), APAP also undergo metabolism by oxidation or conjugation by glucuronate and sulphate to form the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI). Moreover, the NAPQI is detoxified by conjugation with reduced glutathione (GSH). Interestingly, APAP is also metabolized in the kidney by deacetylation reaction in the presence of N-deacetylase enzyme into another severely toxic but minor metabolite, p-aminophenol. Both NAPQI and p-aminophenol shows nephrotoxicity as well as hepatotoxicity. Hence, the long-term therapeutic dose use and unnecessary overdose of APAP are of great concern as prolonged negligence may cost the nephrotoxicity that may lead to uremia and finally to kidney failure. It has recently been investigated that probiotic supplementation inhibits the sequential events associated with APAP-induced nephrotoxicity. This review emphasizes the role of different probiotics that have already been investigated in nephrotoxicity or uremia caused by APAP overdose.