ACUTE KIDNEY INJURY FROM MONONUCLEAR CELL-PREDOMINATED INTERSTITIAL NEPHRITIS AFTER THE INTRODUCTION OF GLUCAGON-LIKE PEPTIDE-1 AGONISTS: A CASE REPORT

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-1211, Poster Board= FRI-052

Introduction:

GLP-1 receptor agonists (GLP-1 RAs) are glucose-lowering agents and antiproteinuric agents widely used nowadays in diabetes patients with proven benefits in delaying the progression of diabetic kidney disease (DKD) along with weight and blood pressure control. To date, kidney injury from GLP-1 RAs, especially for dulaglutide, is scarcely reported. The reported cases ranged from mild presentation to dialysis at presentation and occurred 2 days to 2 years after GLP-1 RAs initiation.

Methods:

We report a case of DKD patient who developed an episode of interstitial nephritis after the administration of dulaglutide.

Results:

A 63-year-old female with diabetic kidney disease in stage 3b and depressive disorder was prescribed dulaglutide 0.75 mg per week subcutaneously in August 2023 due to persistent albuminuria despite the maximum tolerated dose of azilsartan. Sodium-glucose Cotransporter-2 Inhibitor was not prescribed due to frequent urinary tract infections. Serum creatinine at the 2-month follow-up was increased and then doubled despite the decrease of azilsartan and no volume loss. Potential nephrotoxic medications were discontinued. Kidney biopsy revealed active interstitial nephritis and diabetic nephropathy without immune complex deposition. Azilsartan and chlorthalidone could be successfully rechallenged after almost complete recovery of kidney function.

Figure 1 Progression of kidney function in correlation with the anti-proteinuric and anti-diabetic medications dosage adjustment. Other concurrent medications include linagliptin 5 mg/day, verapamil (sustained release) 480 mg/day, sodium bicarbonate 1200 mg/day, ergocalciferol 20,000 unit/week, vitamin B complex, atorvastatin 20 mg/day, hydralazine 50 mg/day, Ketosteril® 4 tablets/day, folic acid 5 mg/day, calcium polystyrene sulfonate 5 g/day, intravenous iron sucrose 100 mg every 4 weeks, and mirtazapine 15 mg/day.

Figure 2 Low and high-power fields of hematoxylin and eosin stain of kidney biopsy, showing lymphocyte-predominate tubulointerstitial nephritis.

Figure 2 Low and high-power fields of hematoxylin and eosin stain of kidney biopsy, showing lymphocyte-predominate tubulointerstitial nephritis.

Conclusions:

Despite the established renoprotective effect of the GLP-1 RAs, acute to chronic tubulointerstitial nephritis could rarely occur, necessitating dialysis in some cases. This renders the need for vigilant monitoring after the drug initiation or dose adjustment. Nevertheless, this does not prevent the prescription of GLP-1 RAs to alleviate the DKD progression in indicated patients.

This abstract was also submitted for the Nephrology Society of Thailand Annual Meeting 2024 congress.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.