A systematic review of semaglutide-associated kidney injury case reports.

BACKGROUND: Although semaglutide is widely used due to its efficacy in glycemic control and weight reduction, cases of the associated adverse drug reactions (ADRs), including kidney injury, have gradually increased. This systematic review aimed to summarize reported cases and case series of semaglutide-associated renal injury and their clinical and laboratory features. METHODS: Case reports and case series on ADRs associated with semaglutide published in English and Chinese were systematically retrieved using relevant keywords from PubMed/MEDLINE, Web of Science, Embase, the Cochrane Library, and the Chinese National Knowledge Infrastructure (CNKI) database from database inception to October 31, 2025. Demographic characteristics, clinical information, ADRs, kidney-related laboratory tests, and outcomes were extracted. We used the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports (JBI Case Report Checklist) to evaluate the quality of each included study. RESULTS: A total of 20 cases (7 males and 13 females) from 18 studies were included after screening 1039 selected publications, with patient ages ranging from 29 to 83 years. Most patients received semaglutide via subcutaneous injection for weight loss or blood sugar reduction. Except for one case with unknown history, all patients had a pre-existing medical condition and were receiving concomitant medications. ADRs occurred at the standard recommended dose, ranging from 0.25 to 2.0 mg and included acute kidney injury (AKI), acute renal failure (ARF), and acute interstitial nephritis (AIN). Twelve cases were diagnosed through renal biopsy, and the remaining eight cases were diagnosed based on renal function parameters. The dosage varied from 0.25 to 2.0 mg per week. The majority of patients developed ADRs after multiple administrations. The clinical manifestations of the patients were diverse. Following treatment, 17 patients improved or recovered, outcomes were not reported in two patients, and one patient did not recover. CONCLUSION: Semaglutide use may be associated with kidney damage, which may be irreversible. Clinicians should be cautious when prescribing semaglutide to individuals with underlying conditions and those receiving concomitant medications, and should ensure regular monitoring of kidney function after treatment initiation.