Acute Kidney and Liver Injury Associated With Low-Dose Liraglutide in an Obese Adolescent Patient

In 2020, the US Food and Drug Administration approved liraglutide (glucagon-like-peptide-1-receptor-agonist) as an adjunctive therapy for weight management in adolescents aged 12 to 18 years in combination with a reduced-calorie diet and increased physical activity. The 2023 American Academy of Pediatrics guidelines recommend pharmacotherapy with glucagon-like-peptide-1-receptoragonist as a second-line therapy in obesity management. Although reports in adults have suggested a link between liraglutide and adverse effects including hepatic injury and acute kidney injury (AKI), these effects have not previously been reported among adolescents treated with liraglutide for weight loss. We present a 17-year-old male who developed AKI and evidence of hepatic injury (significant elevation of hepatic transaminases) after 3 months administration of the lowest dosage of liraglutide (0.6 mg/day) for management of class III obesity. The patient experienced significant loss of appetite, weight loss, and melancholy during the treatment period. One month after discontinuing liraglutide, his mood had improved, his liver enzymes had returned to normal, and AKI had resolved. The Adverse Drug Reaction Probability Scale suggested a high likelihood of a causative association between liraglutide and his symptoms. Our report highlights the importance of vigilance in monitoring for these potential adverse effects among adolescents treated for obesity with any dose of liraglutide. Liraglutide (SAXENDA) is a glucagon-like-peptide-1-receptor-agonist (GLP-1RA) approved by the US Food and Drug Administration and recommended by the American Academy of Pediatrics for managing chronic obesity in patients aged $12 years in combination with a reduced-calorie diet and regular physical activity.^1,2 The recommended starting dose is 0.6 mg/day for 1 week with subsequent weekly increases of 0.6 mg/day as tolerated to a maximum dose of 3 mg/day.^2,3 Side effects of liraglutide that have occurred among $2% of patients include gastrointestinal (GI) symptoms (ie, abdominal pain, vomiting, diarrhea, constipation, nausea), cholelithiasis, injection site reaction, headache, hypoglycemia, fatigue, dizziness, anxiety, and pyrexia.² An association between liraglutide treatment and acute kidney injury (AKI) was reported in adults, particularly at doses above 1.2 mg/day, and mainly among those with diabetes.^3,4 To date, AKI and significant elevations of liver transaminases have not been reported among obese adolescents treated with liraglutide for weight loss. This case report describes the unexpected occurrence of AKI and a significant disturbance in hepatic function after 3 months administration of the lowest dose of liraglutide to an obese adolescent without comorbidities.