Rare Case of Kidney Inflammation After Starting Dulaglutide in a Patient with Diabetic Kidney Disease

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.

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.

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.

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.