It’s known that acetaminophen (APAP) overdose often leads to hepatotoxicity and nephrotoxicity. Previous studies have shown that Tanshinone IIA (Tan IIA) could protect against APAP-induced hepatotoxicity via activating the Nrf2 pathway. In the present study, we further investigated the preventative effect of Tan IIA to APAP-induced nephrotoxicity. Oral supplementation of Tan IIA (30 mg/kg/day) prior to APAP intoxication (200 mg/kg) dramatically reduced APAP-induced nephrotoxicity as evidenced by histopathological evaluation and serum CRE levels. Tan IIA pretreatment promoted the efflux of the toxic intermediate metabolite N-acetyl-p-benzoquinone imine (NAPQI) from mouse kidney, thus reducing its injury to tissue. After Tan IIA pretreatment, significant induction of Nrf2, Mrp2, and Mrp4 mRNA and protein expression was detected in Nrf2+/+ mice kidneys, however, much lower increase of Mrp2 and Mrp4 mRNA and protein expression was observed in Nrf2−/− mice kidneys. Consistent with our observations in vivo, Tan IIA increased the mRNA and protein expression of Nrf2-MRP2/4 pathway and promoted the nuclear Nrf2 accumulation compared with APAP treatment alone in HK-2 cells. Collectively, the findings in this study demonstrated that Tan IIA facilitates the clearance of toxic intermediate metabolite NAPQI from the kidney by up-regulating the Nrf2-Mrp2/4 pathway, thereby, performing a preventive effect against APAP-induced nephrotoxicity.