A 63-year-old woman with diabetic kidney disease developed interstitial nephritis after starting dulaglutide, with kidney function almost fully recovering after stopping the drug — highlighting the need for monitoring despite GLP-1 drugs' generally kidney-protective reputation.
Creatinine doubled in 2 monthsA patient started on dulaglutide for diabetic kidney disease experienced rapid kidney function decline from interstitial nephritis, recovering almost completely after drug discontinuation
What the researchers found
A 63-year-old woman with stage 3b diabetic kidney disease was prescribed dulaglutide 0.75 mg/week due to persistent albuminuria despite maximum tolerated dose of azilsartan. At 2-month follow-up, serum creatinine increased and subsequently doubled. No other causes of kidney injury (including volume depletion) were identified.
Kidney biopsy revealed active mononuclear cell-predominated interstitial nephritis alongside diabetic nephropathy, without immune complex accumulation. After discontinuing dulaglutide, kidney function achieved almost complete recovery without steroid therapy. The patient was successfully rechallenged with azilsartan and chlorthalidone, confirming dulaglutide as the causative agent.
Why it matters
As GLP-1 receptor agonists are increasingly prescribed for diabetic kidney disease specifically because of their renal protective effects, clinicians must remain aware that rare adverse kidney reactions can occur. This case demonstrates that interstitial nephritis — though uncommon — should be considered when kidney function unexpectedly worsens after GLP-1 RA initiation. Early recognition and drug discontinuation led to near-complete recovery, underscoring the importance of monitoring.
How the study worked
This is a clinical case report of a single patient. The diagnostic workup included serial serum creatinine monitoring, evaluation and exclusion of other nephrotoxic causes, and kidney biopsy with histopathological analysis. The clinical response to dulaglutide discontinuation (drug dechallenge) and successful rechallenge with other medications provided evidence of causality.
What this study cannot tell us
This is a single case report — the lowest level of clinical evidence. A definitive causal link between dulaglutide and the interstitial nephritis cannot be established from one patient. The biopsy showed coexisting diabetic nephropathy, complicating the attribution. No formal drug rechallenge with dulaglutide was performed (only other medications were rechallenged). The mechanism by which GLP-1 RAs might trigger interstitial nephritis is not understood.
How to read the evidence
This is a single case report — the lowest tier of clinical evidence. While the temporal relationship (drug start → kidney decline → drug stop → recovery) and biopsy confirmation support the association, a single case cannot establish causality or estimate incidence. It serves as a clinical alert rather than definitive evidence.
When this study was published
Published in 2025, this case report is very current and relevant as GLP-1 receptor agonist prescriptions continue to surge. The report adds to pharmacovigilance data for this increasingly used drug class.
The bigger picture
GLP-1 receptor agonists have shown kidney-protective effects in large clinical trials, leading to their recommendation for diabetic kidney disease. However, post-marketing surveillance continues to identify rare adverse events that were not captured in clinical trials. This case adds to a small but growing literature documenting kidney injury from GLP-1 RAs, ranging from mild to dialysis-requiring. As millions more patients start these drugs, even rare adverse events become clinically significant.
Questions still open
- What is the mechanism by which GLP-1 receptor agonists could trigger interstitial nephritis — is it an immune-mediated reaction?
- Should patients with advanced diabetic kidney disease receive more frequent creatinine monitoring after starting GLP-1 drugs?
- Would other GLP-1 receptor agonists cause the same reaction in this patient, or is this drug-specific?
Common questions
Are GLP-1 drugs still safe for the kidneys?
What happened when the patient stopped dulaglutide?
Read the original research
Acute Kidney Injury from Mononuclear Cell-Predominated Interstitial Nephritis After Introduction of a Glucagon-Like Peptide-1 Receptor Agonist: A Case Report.
The American journal of case reports, 26, e949913
Citation
Itsathitpaisarn, Raweekarn; Suksawad, Nattavong; Wongwikrom, Watsapol; Surintrspanont, Jerasit; Thongsricome, Thana. (2025). Acute Kidney Injury from Mononuclear Cell-Predominated Interstitial Nephritis After Introduction of a Glucagon-Like Peptide-1 Receptor Agonist: A Case Report.. The American journal of case reports, 26, e949913. https://doi.org/10.12659/AJCR.949913