A case report of acute kidney injury caused by semaglutide in combination with multiple medications

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Author: GU Jiamei ¹ TANG Chenquan ² JIANG Yi ² YIN Hao ² FENG Chen ²  XUE Yi ²

Affiliation: 1. Department of Pharmacy, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu Province, China 2. Department of Nephrology, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou 215101, Jiangsu Province, China

Keywords: Semaglutide Metformin Dapagliflozin Sacubitril/Valsartan Acute kidney injury Adverse reactions

DOI: 10.12173/j.issn.1005-0698.202504122

Reference: GU Jiamei, TANG Chenquan, JIANG Yi, YIN Hao, FENG Chen, XUE Yi. A case report of acute kidney injury caused by semaglutide in combination with multiple medications[J]. Yaowu Liuxingbingxue Zazhi, 2025, 34(7): 835-840. DOI: 10.12173/j.issn.1005-0698.202504122.[Article in Chinese]  Copied

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Abstract

A 53-year-old female patient with type 2 diabetes mellitus, hypertension, and hyperlipidemia, on long-term therapy with metformin, gliclazide, dapagliflozin, sacubitril/valsartan, lercanidipine, and atorvastatin, was initiated on semaglutide due to obesity and suboptimal glycemic control. Patient using semaglutide 0.25 mg and 0.5 mg without adverse effects, and developed gastric discomfort after adjusting dose to 0.75 mg. She remained on this dose for 7 weeks. Upon further dose escalation to 1 mg, she experienced persistent nausea, vomiting, and diarrhea. Fifteen days later, she was admitted to the hospital with impaired consciousness. Laboratory findings revealed blood urea nitrogen of 35.4 mmol·L^-1 and serum creatinine of 825 μmol·L^-1. The patient was diagnosed with acute kidney injury (AKI), which was considered related to semaglutide, metformin, dapagliflozin, and sacubitril/valsartan. All medications were discontinued. Following symptomatic treatment including fluid resuscitation, volume expansion, and hemodialysis, the patient's renal function gradually recovered. The association between AKI and semaglutide, metformin, dapagliflozin, and sacubitril/valsartan was evaluated using the Naranjo’s Assesment Scale, the results were all "probable". This case highlighted that clinical use of semaglutide requires careful consideration of concomitant medications and vigilance for renal impairment. In the event of AKI, prompt assessment, discontinuation of medications with potential renal impairment and symptomatic management were necessary to ensure safe medication administration.

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