Acute Renal Failure: A Rare and Uncommon Side Effect of Semaglutide

Thursday, May 12, 2022

12:35 PM – 12:50 PM

Location: Station 3, Sapphire West Foyer

Poster Presenter(s)

MO
Michele Obeid, MD
Endocrinology Fellow
University of Illinois at Chicago

Submitter(s)

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Arian Nowrozi, MD
Advocate Christ Internal Medicine Residency

Co-Author(s)

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Joumana Chaiban, MD, MBA, FACE
Associate Professor of Clinical Medicine
University of Illinois at Chicago/Advocate Christ Medical Center

Introduction : Glucagon-like peptide-1(GLP-1) receptor agonists play a significant role in treating type 2 diabetes and obesity. Their extended half-life allows for once-weekly injections1. Semaglutide has cardioprotective and renoprotective effects2 with decreased cardiovascular death rates, nonfatal myocardial infarction, or nonfatal stroke3. SUSTAIN 6 trial, a post hoc analysis that assessed its effects on mean estimated glomerular filtration rate (eGFR), did not show adverse renal outcomes regardless of baseline renal function4. To our knowledge, only two cases5 report acute kidney injury (AKI) that developed on a background of chronic kidney disease after starting semaglutide6. We discuss a patient with normal kidney function who developed AKI after starting Semaglutide.

Case Description : A 59-year-old female with type 2 diabetes, hypothyroidism, and remote breast cancer presents for decreased urinary output after her first 3 weekly doses of 0.25mg Semaglutide injections. She had a baseline creatinine (Cr) of 0.8mg/dl (eGFR 76 mL/min). She denied the use of non-steroidal anti-inflammatory medications, over-the-counter supplements and urinary tract infection symptoms. Approximately 4 weeks after starting Semaglutide, she noted decreased urinary output along with nausea and vomiting. Labs revealed an elevated Cr of 6.54 mg/dl (eGFR 6 mL/min) with an even higher repeat at 9.45 mg/dl. Nephrology recommended emergent hemodialysis. Kidney biopsy showed diffuse acute tubular injury with severe global glomerulosclerosis and moderate chronic tubulointerstitial changes without evidence of glomerulonephritis, acute interstitial nephritis, or vasculitis. She required 4 hemodialysis sessions over the course of ten days with an improvement of her kidney function (Cr 1.55 mg/dl, eGFR 36 mL/min) and ultimately discontinuation of dialysis

Discussion : Adverse effects of Semaglutide still need to be researched. Available reports with a decline in kidney function are sparse. Previous clinical trials did not show any significant effect of GLP-1 on renal function, AKI was described in two individuals5. Our case is unique since AKI occurred in a patient with normal baseline kidney function. Since the half-life of Ozempic is about seven days6, our patient’s renal function recovered after four weeks. Luckily, the kidney damage was reversible. Physicians should be aware of such potential rare complications when prescribing GLP-1 agonists and closely monitor renal function after initiation.