ESPE Abstracts

Background: Liraglutide (SAXENDA®) is a glucagon-like peptide 1 (GLP-1) receptor agonist approved as an adjunct for chronic weight management in combination with a reduced-calorie diet and increased physical activity. Previous case reports have suggested an association between liraglutide use and acute kidney injury in adults, particularly at maintenance doses of 1.2 mg/day or higher. However, there is less data on the impact of liraglutide in the adolescent population.

Case Presentation: We present a case of a 17-year-old adolescent who was admitted to the hospital with symptoms of mild vomiting, abdominal pain, anorexia, and low urine output persisting for three days. Laboratory tests revealed elevated levels of serum creatinine (1.92 mg/dL) and uric acid (11 mg/dL). Additionally, the patient exhibited elevated liver enzyme levels (AST 187 U/L, ALT 230 U/L), hyperbilirubinemia (2.15 mg/dL), and elevated LDH levels (650 U/L). He had been receiving liraglutide treatment for morbid obesity class 3 (BMI 50), at a minimal dosage of 0.6 mg/day for the preceding three months and experienced significant weight loss of over 20 kg during that period. The dose was not increased due to significant loss of appetite and successful weight loss with that low dose. Notably, the patient reported experiencing changes in mood, particularly melancholy.

Treatment and Outcome: The patient's treatment involved discontinuing liraglutide, implementing a low-salt and low-potassium diet, rehydration, and administering of proton pump inhibitors and antiemetics. After four days of hospitalization, the patient was discharged with restored kidney function, and improved hepatocellular function. Follow-up evaluation after 2 weeks revealed normalization of liver enzymes, improved appetite, and resolution of the depressive mood.

Discussion and conclusion: The Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's acute kidney injury, hepatocellular disorder, and liraglutide use. Thus, this is the first documented case of acute interstitial nephritis with a hepatocellular disorder induced by the lowest dose of liraglutide in real life setting in the adolescent population. Healthcare providers should be aware of the potential complication of liraglutide use, even at low doses, which can lead to acute kidney injury and hepatocellular disorders in adolescents. Patients should be educated about the importance of reporting any unusual weight loss or prolonged gastrointestinal or urinary symptoms. Further prospective real-life research is warranted to enhance our understanding of the risks and benefits associated with liraglutide treatment in adolescents.