A 26 yr old man experienced acute hepatic and renal damage after ingestion of an acetaminophen-containing compound. The clinical course, laboratory data and kidney biopsy were consistent with acute renal failure due to tubular necrosis. The patient required dialysis but ultimately renal function returned to normal. The etiology of the renal lesion was most likely nephrotoxicity due to acetaminophen. The clinical and experimental literature on acute renal failure associated with acetaminophen overdosage is reviewed. Other drugs may precondition the kidney to tubular damage from this agent.