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[33, 34, 35, 36] Mechanism: Typically pre-renal, occurring in the setting of volume depletion from GI losses (nausea, vomiting, diarrhea, reduced oral intake) More frequently seen at higher, obesity-level doses Although generally reno-protective long term, post-marketing data describe acute rises in creatinine following days to weeks of significant GI symptoms Risk factors: Underlying chronic kidney disease Concomitant use of ACE inhibitors, ARBs, diuretics, or SGLT2 inhibitors ED Management: IV fluids Hold GLP-1 and contributing medications Usually reversible with supportive care Future Directions GLP-1 receptor agonists are rapidly evolving beyond their original indications in diabetes and obesity

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Modulating the metabolicimmune interface Mitochondrial metabolism is tightly coupled to innate immune signaling, which may be an additional target to attenuate mtDNA-driven neuroinflammation

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