Antidiabetic Medication-Induced Acute Interstitial Nephritis: Case Report and Literature Search

Abstract

Introduction Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is a recognised treatment for type 2 diabetes mellitus (T2DM). It mimics human GLP-1 and works by augmenting insulin secretion, inhibiting glucagon secretion and inhibiting gastric acid secretion.1 It has been shown to not only improve glycaemic control in people with diabetes, but also result in weight loss, reduced hypoglycaemic episodes, reduced albuminuria, reduced progression to macroalbuminuria and reduced incidence of myocardial infarction and stroke events.2–5 Gastrointestinal upset is the commonest reported side effect, which occurs in up to 56% of patients in clinical trials. Furthermore, BNF recommends avoiding liraglutide treatment in end-stage renal disease/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 (depending on brand), due to the increased risk of adverse events. We present a rare case of a female with chronic kidney disease (CKD), whose treatment with liraglutide was associated with rapid deterioration of renal function and tubulointerstitial nephritis. Our literature search highlighted one previous case, thus we would like to raise awareness of this potential rare side effect of liraglutide treatment.6 We have further conducted a literature search of all case reports noting associations of glucose-lowering therapies with acute interstitial nephritis to raise awareness of this potential complication.