Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana 47907, USA.
Pharmacotherapy. 2012 Jan;32(1):e7-11. doi: 10.1002/PHAR.1014.
Published case reports have documented the relationship between exenatide use and acute kidney injury. However, to our knowledge, no cases of this adverse effect with liraglutide, another glucagon-like peptide-1 receptor agonist approved for the treatment of type 2 diabetes mellitus, have been reported. We describe a 53-year-old Caucasian woman who came to a community hospital with severe and progressively worsening gastrointestinal symptoms for several weeks, leading to dehydration and development of acute kidney injury. Laboratory results showed an increase in her serum creatinine concentration to 22.8 mg/dl and blood urea nitrogen to 150 mg/dl; she also had lost 8.9 kg in the previous month. One month earlier, the patient had begun liraglutide 1.8 mg/day subcutaneously for uncontrolled type 2 diabetes. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship (score of 3) between the patient's development of acute kidney injury and liraglutide. Renal biopsy and laboratory testing were helpful in ruling out other potential causes of renal failure and adverse drug reactions due to other drugs such as ciprofloxacin and quinapril. After the reports of the renal biopsy were obtained, liraglutide was determined to be a likely cause of acute tubular necrosis. The patient was successfully treated with discontinuation of liraglutide, volume repletion, and hemodialysis. To our knowledge, this is the first documented case of liraglutide-induced acute tubular necrosis. Clinicians should be aware of this possible complication and closely follow liraglutide's dosage titration recommendations in the package insert. Patients should also be educated about the need to report unusual or prolonged gastrointestinal symptoms.
已发表的病例报告记录了 exenatide 与急性肾损伤之间的关系。然而，据我们所知，另一种胰高血糖素样肽-1 受体激动剂利拉鲁肽（用于治疗 2 型糖尿病）尚未报告有这种不良反应的病例。我们描述了一位 53 岁的白种女性，因数周来严重且逐渐加重的胃肠道症状而到社区医院就诊，导致脱水和急性肾损伤。实验室结果显示她的血清肌酐浓度升高至 22.8mg/dl，血尿素氮升高至 150mg/dl；她在过去一个月内体重减轻了 8.9kg。一个月前，患者开始皮下注射利拉鲁肽 1.8mg/天，用于治疗未控制的 2 型糖尿病。使用 Naranjo 药物不良反应概率量表表明，患者急性肾损伤与利拉鲁肽之间可能存在关系（评分 3）。肾活检和实验室检测有助于排除其他可能导致肾衰竭的潜在原因和由于其他药物（如环丙沙星和喹那普利）引起的药物不良反应。在获得肾活检报告后，确定利拉鲁肽是急性肾小管坏死的可能原因。通过停止使用利拉鲁肽、补液和血液透析，患者成功得到治疗。据我们所知，这是首例有记录的利拉鲁肽引起的急性肾小管坏死病例。临床医生应意识到这种可能的并发症，并密切遵循包装说明书中利拉鲁肽剂量滴定建议。还应教育患者注意报告异常或持续时间较长的胃肠道症状的必要性。
