Abstract: FR-PO0759
ANCA-Negative, Pauci-Immune Crescentic Glomerulonephritis After GLP-1 Receptor Agonist Exposure
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Almutar, Sara, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Al Asimah Governate, Kuwait
- Alsharhan, Loulwa, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Al Asimah Governate, Kuwait
- Altaleb, Ahmed, Mubarak Al-Kabeer Hospital, Jabriya, Hawalli Governorate, Kuwait
Introduction
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely prescribed for type 2 diabetes mellitus (T2DM) and obesity, with established cardiovascular and renoprotective benefits. Rare cases of GLP-1RA-associated cutaneous leukocytoclastic vasculitis have been reported, whereas systemic small vessel vasculitis with kidney involvement remains exceedingly rare. We report the first case of biopsy-proven ANCA-negative pauci-immune crescentic glomerulonephritis following GLP-1RA exposure, highlighting a potential novel immune-mediated adverse event.
Case Description
A 40-year-old woman with T2DM, hypothyroidism, and obesity presented with acute kidney injury due to obstructive uropathy. Her serum creatinine (sCr) peaked at 200 μmol/L, from a normal baseline. Double-J stent placement resulted in partial improvement in sCr to 170 μmol/L. Two weeks later, sCr increased to 250 μmol/L accompanied by subnephrotic proteinuria and microscopic hematuria. Notably, she had initiated dulaglutide for weight loss 4 weeks prior to presentation, which she discontinued after developing a localized skin reaction. Serology revealed negative ANA, dsDNA, MPO and PR3-ANCA, with normal complements. Infectious and malignancy screening were negative. Kidney biopsy demonstrated pauci-immune crescentic glomerulonephritis with 25% cellular and fibrocellular crescents. Given severe kidney involvement, she was treated with cyclophosphamide and glucocorticoids resulting in resolution of hematuria and improvement in kidney function to a sCr of 130 μmol/L at 8 weeks. She received maintenance rituximab for 2 years and remained in renal remission with stable kidney function and inactive urine sediment.
Discussion
The temporal association with GLP-1RA exposure, exclusion of alternative etiologies, and concomitant cutaneous reaction support a drug-induced immune-mediated adverse event. This case highlights the diagnostic challenge of ANCA-negative glomerulonephritis in the absence of a serologic biomarker. Timely kidney biopsy is crucial in patients with unexplained kidney injury following recent drug exposure to enable early treatment and prevent irreversible damage.