Kidney Week

Abstract: SA-PO0321

Confronting the Odds: AKI with Zepbound Use

Session Information

• AKI: Epidemiology and Risk Factors
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Tahir, Maria, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Maria Tahir, MD

• Siddiqi, Mahwash, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Mahwash Siddiqi, MD

• Raza, Muhammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Muhammad Raza, MD

• Abdulbasit, Muhammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Muhammad Abdulbasit, MD

• Miller, Ronald P., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Ronald P. Miller, MD

Introduction

Tirzepatide and other glucagon-like peptide1(GLP-1)agonists are effective for glycemic control and weight management in type 2 diabetes and obesity.Clinical trials have shown tirzepatide’s lower risk of acute kidney injury(AKI)compared to other GLP-1 agonists.Few cases of AKI have been reported,associated with dehydration due to gastrointestinal side effects or comorbidities.

Case Description

44 year old man with prediabetes,hypertension,chronic kidney disease stage 2(baseline creatinine 1.28, GFR 70),class 2 obesity;working on weight loss management with primary care physician started Zepbound injections.He well-tolerated 2.5mg doses, but developed significant gastrointestinal side effects when dose was escalated to 5mg.He presented to ED with severe nausea, vomiting, and inability to eat > 3 weeks.He admitted to minimal oral intake.On physical examination,he had lower abdominal pain,blood pressure 93/56 mmHg and pulse 101bpm,minimal urine output,serum creatinine (SCr) 20.4 mg/dL with blood urea nitrogen(BUN)195 mg/dL with high serum osmolality and metabolic acidosis. Management involved intensive care unit admission, potassium repletion, intravenous fluids, and tirzepatide discontinuation. Renal function improved(SCr 1.28 mg/dL) within 2 weeks after discharge.

Discussion

This case report describes a rare instance of AKI after tirzepatide dose escalation for weight optimization.The temporal association between the accelerated dosing regimen(from 2.5 mg to 5 mg over 1 month),and onset of AKI suggests direct relationship, although multiple confounding factors may be present. Volume depletion due to gastrointestinal adverse effects is a well-known cause of AKI associated with dual gastric inhibitory polypeptide/GLP-1 agonists such as tirzepatide, as noted in the FDA approved labeling. Clinical trials indicate that risk of AKI is not dose-dependent, escalated dosing may have increased the patient’s vulnerability to AKI by exceeding physiological compensatory capacity.

This case report documents a rare occurrence of AKI in a pre-diabetic,multimorbid patient. The AKI likely resulted from volume depletion, which led to increased renal vulnerability in a patient with complex comorbidities.Further research is needed to establish optimal monitoring strategies and identify specific risk factors for rare renal adverse events in pre-diabetic patients treated with tirzepatide, ensuring safe and effective therapeutic use.