Systematic Review Identifies 20 Semaglutide-Associated Kidney Injury Cases, Including AKI and AIN
Background
While semaglutide is widely recognized for its efficacy in glycemic control and weight reduction, there's a growing concern regarding associated adverse drug reactions (ADRs), particularly kidney injury. Despite its widespread use, a comprehensive understanding of the clinical and laboratory features of semaglutide-associated renal injury cases has been lacking. This systematic review addresses this gap by aggregating and summarizing reported instances, providing crucial insights into this rare but significant complication.
Study Design
Researchers conducted a systematic review of case reports and case series detailing semaglutide-associated ADRs. They searched PubMed/MEDLINE, Web of Science, Embase, Cochrane Library, and CNKI databases from inception to October 31, 2025, using relevant keywords in English and Chinese. After screening 1039 publications, 18 studies reporting 20 cases were included. Data extracted included demographics, clinical information, ADRs, kidney-related laboratory tests, and outcomes. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports (JBI Case Report Checklist).
Results
A total of 20 cases (from 18 studies) of semaglutide-associated kidney injury were identified, comprising 7 males and 13 females, with patient ages ranging from 29 to 83 years. Most patients received semaglutide via subcutaneous injection for weight loss or blood sugar reduction. All but one patient had pre-existing medical conditions and were on concomitant medications. ADRs occurred at standard recommended doses, ranging from 0.25 to 2.0 mg weekly, and included acute kidney injury (AKI), acute renal failure (ARF), and acute interstitial nephritis (AIN). The majority developed ADRs after multiple administrations. > Twelve cases were definitively diagnosed through renal biopsy, while the remaining eight cases were diagnosed based on renal function parameters. Following treatment, 17 patients showed improvement or full recovery, with outcomes unreported for two patients.
Key Findings
- A systematic review identified 20 cases of semaglutide-associated kidney injury across 18 studies.
- Reported kidney injuries included
acute kidney injury(AKI),acute renal failure(ARF), andacute interstitial nephritis(AIN). - ADRs occurred at standard semaglutide doses, ranging from 0.25 to 2.0 mg weekly.
- The majority of patients (17 out of 20) improved or recovered following treatment for kidney injury.
- Diagnosis was confirmed by renal biopsy in 12 cases and by renal function parameters in 8 cases.
Why It Matters
This systematic review highlights that semaglutide-associated kidney injury, though rare, is a documented adverse event that clinicians and users should be aware of. The occurrence at standard doses and in patients with pre-existing conditions underscores the importance of vigilant monitoring of renal function, especially in vulnerable populations or those on multiple medications. While this doesn't suggest a change in standard dosing protocols, it reinforces the need for careful patient selection and ongoing assessment. For individuals using semaglutide, particularly those with underlying kidney issues or polypharmacy, discussing regular kidney function checks with their healthcare provider is a prudent step to mitigate potential risks.
semaglutide
kidney-injury
adr
acute-kidney-injury
systematic-review
case-reports