Acute tubular injury following a single dose of tirzepatide in a patient with diabetic kidney disease: a cautionary case

Tirzepatide is a synthetic polypeptide with dual agonistic action at glucose-dependent insulinotropic peptide and glucagon-like peptide-1 receptors. This drug was approved in 2022 by regulatory agencies for the treatment of type 2 diabetes mellitus. In addition to glycaemic control [1], tirzepatide also promotes weight loss in obese individuals [2]. Tirzepatide was found to slow kidney function decline and reduce proteinuria in obese type 2 diabetic patients [3]. Given its pleiotropic benefits, the prescription of tirzepatide is expected to increase in the near future. The pharmacokinetics of tirzepatide is not altered by kidney failure and it can be initiated at any level of kidney function [4]. The drug is generally well tolerated and the most common adverse effects include nausea, anorexia, and diarrhoea [5]. Acute kidney injury (AKI) is a rare adverse effect of tirzepatide and is attributable to dehydration resulting from nausea, vomiting, and diarrhoea [5]. We report the occurrence of AKI necessitating temporary dialysis in a patient with diabetic kidney disease after exposure to this novel drug.