Can Skyrizi (Risankizumab) cause impaired renal function?

Renal Safety of Skyrizi (Risankizumab)

Skyrizi (risankizumab) does not have significant documented kidney side effects and can be considered safe for renal function based on available evidence.

Mechanism and Safety Profile

Risankizumab is an interleukin-23 (IL-23) antagonist approved for the treatment of moderate to severe plaque psoriasis 1. Unlike many other medications that have established nephrotoxic effects, Skyrizi has not been specifically identified in guidelines as causing kidney dysfunction.

Key points about Skyrizi's renal profile:

• No specific renal warnings or dose adjustments for Skyrizi appear in major nephrology guidelines
• IL-23 inhibitors as a class have not been prominently associated with nephrotoxicity
• Skyrizi does not appear in lists of medications requiring dose adjustment for renal impairment 2

Contrast with Known Nephrotoxic Medications

Many medications require careful monitoring or dose adjustments in patients with kidney disease:

• NSAIDs: Commonly associated with nephrotoxicity, especially with chronic use 3
• Tenofovir-containing antiretrovirals: Require monitoring for proximal tubulopathy 4
• Aminoglycosides: Need dose adjustments and monitoring for nephrotoxicity 2
• ACE inhibitors/ARBs: Require monitoring of serum creatinine and potassium 2

Unlike these medications, Skyrizi does not appear in guidelines recommending renal monitoring or dose adjustments.

Monitoring Recommendations

While specific monitoring for Skyrizi-related kidney effects is not mandated in guidelines, general principles of medication safety suggest:

• Baseline kidney function assessment before starting any biologic therapy
• Routine kidney function monitoring as part of standard care for patients on chronic medications
• Increased vigilance in patients with pre-existing kidney disease or risk factors

Special Populations

For patients with pre-existing kidney disease:

• No specific contraindications for Skyrizi use in patients with reduced kidney function
• No dose adjustments are recommended in major guidelines for patients with impaired renal function
• Unlike medications that require specific dose adjustments in kidney disease (such as certain antibiotics 2 or antihypertensives 2), Skyrizi does not have such requirements

Clinical Implications

When considering Skyrizi for patients with or without kidney disease:

1. Standard pre-treatment laboratory evaluation including kidney function is appropriate
2. Routine monitoring of kidney function as part of standard care is sufficient
3. No specific renal-focused monitoring beyond standard care appears necessary based on current evidence
4. If kidney function changes occur during treatment, consider other potential causes before attributing to Skyrizi

Conclusion

Based on available evidence and clinical guidelines, Skyrizi (risankizumab) does not appear to cause significant kidney side effects. This contrasts with many other medications that have established nephrotoxic potential requiring specific monitoring or dose adjustments. Standard kidney function monitoring as part of routine care is appropriate when using Skyrizi.