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

BACKGROUND: 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. CASE PRESENTATION: 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/m. 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. CONCLUSION: 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.