DECIPHERING THE PUZZLE

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INTRODUCTION/BACKGROUND GLP-1 agonists are crucial treatments for type 2 diabetes and obesity due to their positive impact on glucose control and weight. However, concerns have arisen about their potential to cause pre-renal acute kidney injury (AKI), typically attributed to gastrointestinal side effects. This case presents a notable anomaly: AKI occurring without gastrointestinal symptoms, prompting further investigation into the mechanisms behind GLP-1 agonist-associated AKI. CASEA 35-year-old Malay male was seen with morbid obesity class II, young-onset hypertension and stable chronic kidney disease stage 3. He was started on semaglutide at 0.25 mg weekly, with plans to up titrate to 0.5 mg weekly. Upon initiation, renal function showed a concerning decline in eGFR from 54 to 35 mL/min/1.73 m2 . Despite ruling out gastrointestinal side effects or dehydration and obstructive uropathy through ultrasound, semaglutide was temporarily withheld. After a month without the medication, his eGFR improved to 53 mL/min/1.73 m2 . We then cautiously initiated Liraglutide at 0.6 mg OD which resulted in a weight reduction from 98 kg to 94 kg within a month. However, renal function deteriorated further, with eGFR dropping to 34 mL/min/1.73 m2 and creatinine levels rising to 204 mmol/L. Understanding the importance of preserving renal function, we subsequently discontinued GLP-1 agonist therapy. CONCLUSIONDespite the absence of gastrointestinal side effects, GLP-1 receptor agonists can still be associated with acute kidney injury. Hence, it is important to monitor renal profile regularly, especially when starting treatment with these medications.

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