司美格鲁肽联合多种药物致急性肾损伤1例

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【中图分类号】 R977.1+5 【文献标识码】A

A case report of acute kidney injury caused by semaglutide in combination with multiple medications

GU Jiamei1，TANG Chenquan²， JIANG Yi²，YIN Hao²，FENG Chen²，XUEYi²

1.Departmentof Pharmacy，Suzhou Hospital of Integrated Traditional Chineseand Western Medicine，Suzhou215101，JiangsuProvince，China

2.DepartmentofNephrology，Suzhou HospitalofIntegrated Traditional Chineseand WesternMedicine，Suzhou 215101，Jiangsu Province， China

Corresponding author： XUE Yi， Email： xybft2012@163.com

【Abstract】A 53-year-old female patient with type 2 diabetes mellitus， hypertension， and hyperlipidemia， on long-term therapy with metformin， gliclazide，dapagliflozin， sacubitril/valsartan， lercanidipine，and atorvastatin，was initiated on semaglutide due to obesity and suboptimal glycemic control. Patient using semaglutide 0.25mg and 0.5mg without adverse effects，and developed gastric discomfort after adjusting dose to 0.75mg . She remained on this dose for7 weeks.Upon further dose escalation to 1mg ，she experienced persistent nausea， vomiting，and diarrhea. Fifteen days later， she was admitted to the hospital with impaired consciousness.Laboratory findings revealed blood urea nitrogen of 35.4mmol⋅L-1 and serum creatinine of 825μmol⋅L-1 . The patient was diagnosed with acute kidneyinjury（AKI），which wasconsidered related tosemaglutide，metformin，dapagliflozin，andsacubitril/ valsartan. All medications were discontinued. Following symptomatic treatment including fluid resuscitation， volume expansion，and hemodialysis，the patient's renal function graduall recovered.The association between AKI and semaglutide， metformin，dapagliflozin，and sacubitril/valsartan was evaluated using the Naranjo's Assesment Scale，the results were all"probable".This case highlighted that clinical use of semaglutide requires careful consideration of concomitant medications and vigilance for renal impairment.In the event of AKI， prompt assessment， discontinuation of medications with potential renal impairment and symptomatic management were necessary to ensure safe medication administration.

【Keywords】Semaglutide; Metformin; Dapagliflozin; Sacubitril/Valsartan; Acute kidney injury dverse reactions

司美格鲁肽是一种胰高血糖素样肽-1受体激动剂（glucagon-like peptide-1 receptoragonists，GLP-1RA），具有降低血糖、减轻体重，降低心血管事件风险的作用，临床用于2型糖尿病合并肥胖或心血管高风险患者[。（剩余10453字）