Efficacy of semaglutide in IgA nephropathy with obesity: a case report

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide are well-used for type 2 diabetes and obesity, and recent studies show their potential renal benefits in both diabetic and non-diabetic people. However, evidence for semaglutide’s efficacy in IgAN especially in patients with obesity as a comorbidity is limited. A 39-year-old male with a 9-month history of abnormal urine tests was admitted, diagnosed with IgAN (M1E0S0T0C0) and glomerulomegaly, and presented with obesity with BMI 34 kg/m2. After treatment with losartan, dapagliflozin, hydroxychloroquine, and finerenone, the 24-hour proteinuria levels decreased from 2373 mg/day to 1344 mg/day, further dropping to 702 mg/day, and then slightly increased to 920 mg/day. No significant improvement was noted half a month later, with the level remaining at 915 mg/day. We then initiated treatment with semaglutide. Following the introduction of semaglutide, a significant reduction in proteinuria was observed within four months, decreasing from 915 mg/day to 320 mg/day. Concurrently, the patient experienced a reduction in body weight, dropping from 110 kg to 95 kg over the same period. The patient's renal function remained stable throughout the follow-up, and no significant adverse drug reactions have been reported. In this case of IgAN with obesity, adding semaglutide to standard therapy effectively reduced proteinuria and body weight, with stable renal function and good tolerability.