SHM Converge Scientific Abstract ePoster Gallery-How Low Can You Go? Tirzepatide Induced Renal Failure

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This case report describes a serious adverse event associated with tirzepatide, a weekly subcutaneous GIP/GLP-1 receptor agonist approved for type 2 diabetes and weight loss. While tirzepatide is generally effective and considered safe, gastrointestinal side effects are common and can lead to dehydration and hemodynamic instability.<br /><br />A 49-year-old man with obesity, hypertension, type 2 diabetes, obstructive sleep apnea, and gout developed 10 days of non-bloody diarrhea, a 20-pound weight loss, and profound hypotension after starting tirzepatide 2.5 mg weekly. He was also taking lisinopril and allopurinol. On presentation, he was ill-appearing and dehydrated, with blood pressure of 69/44 mmHg. Laboratory testing showed severe acute kidney injury with creatinine 10.9 mg/dL from a baseline of 1.2 mg/dL, hyponatremia, and metabolic acidosis. Imaging did not reveal an acute abdominal process.<br /><br />He was admitted with hypovolemic shock and suspected prerenal acute kidney injury. Treatment included norepinephrine and bicarbonate infusion, with rapid improvement in renal function and hemodynamics. Within 48 hours, his creatinine improved to 1.83 mg/dL, and he later returned to baseline kidney function after discharge. Tirzepatide was stopped, and the patient remained off it at follow-up.<br /><br />The authors note that gastrointestinal adverse effects from tirzepatide are common in clinical trials, but severe kidney injury is rarely reported. In this case, ongoing diarrhea and volume loss, likely worsened by concurrent ACE inhibitor use, precipitated non-oliguric prerenal acute kidney injury. The report emphasizes the need for careful counseling, monitoring, and anticipatory guidance when initiating or titrating tirzepatide, especially in patients at risk for dehydration.

Asset Subtitle

Lauren D. Spaeth

Meta Tag

Author List Kim Jordan, Lauren D. Spaeth

Category Clinical Vignettes

Concept Tirzepatide

Concept Gastrointestinal Side Effects

Concept Weight Loss

Concept Type 2 Diabetes Mellitus

Concept Volume Depletion

Distinguished Non-Finalist

Presenter Organization Ohio Health

Presenting Author Lauren D. Spaeth

Track Adult

Keywords

tirzepatide

acute kidney injury

hypovolemic shock

diarrhea

dehydration

prerenal azotemia

type 2 diabetes

GLP-1 receptor agonist

ACE inhibitor

hemodynamic instability

Tirzepatide

Gastrointestinal Side Effects

Weight Loss

Type 2 Diabetes Mellitus

Volume Depletion