N-acetylcysteine also may attenuate the course of hepatorenal syndrome, a renal vasoconstrictive response of indeterminate nature that develops during advanced liver failure. This effect, shown in experimental settings [9] and in a preliminary clinical report [10], could imply a better preservation of liver function. However, direct renal protective mechanisms may play a role also, considering the ubiquitous distribution of acylases that catalyze the deacetylation of NAC [11]. Indeed, recent studies suggest that NAC may increase intracellular glutathione and ameliorate renal ischemia-reflow injury [12-14], inferior vena cava-occlusion [15] or kidney damage from cis-platinum [16], cyclosporine [17], and other nephrotoxic insults [18, 19]. NAC has been reported recently to prevent radiocontrast nephropathy in high-risk patients [20]. These studies, conducted in a clinical trial without preliminary experiments in animals, underscore the safety of oral NAC administration.