Abstract

Obesity is a well-recognized risk factor for chronic kidney disease (CKD), and proteinuria is an important predictor of progression to end-stage renal disease. Semaglutide, a Glucagon-Like Peptide-1 (GLP-1) receptor agonist, has demonstrated renoprotective potential through weight reduction, anti-inflammatory effects, and improvement in glomerular hyperfiltration. We present a case involving a 27-year-old male with class III obesity (BMI 35.1 kg/m²) and persistent proteinuria. Semaglutide was initiated to address obesity-related renal injury, alongside lifestyle modification and angiotensin receptor blocker administration. Over 20-week follow-up period, the patient achieved significant weight reduction (−13 kg; 14% of baseline weight). Concurrently, proteinuria improved markedly, from dipstick grade +++ (~300 mg/dL) and spot urine protein 247.7 mg/dL at baseline to ++ (~100 mg/dL) and 67.7 mg/dL of follow-up. The urine protein-to-creatinine ratio (UPCR) decreased from 0.93 g/g Cr at baseline to 0.37 g/g Cr at follow-up. Renal function remained stable throughout the observation period. This case suggests that semaglutide may improve obesityassociated proteinuria. However, given the limitations inherent to a single-patient, short-term observation, long-term follow-up and controlled studies are required to validate durability and mechanistic pathways of renal benefit.