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With sufficient glutathione present, NAPQI is very quickly metabolized into sulfate and cysteine compounds, which are readily excreted through the kidneys.[ref] However, when it isnt neutralized, NAPQI is highly reactive and can cause oxidative stress and damage to the liver cells, hepatocytes, leading to cell death

In addition, not all participants were using RAS inhibitors, in part due to intolerance and because of the lower grading for the use of these agents by major guidelines for patients without diabetes and normal blood pressure and microalbuminuria

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However, be cautious not to overdo it