The interplay of maturity-onset diabetes of the young, obesity, uncontrolled hypertension, and cannabinoid hyperemesis in the progression to end-stage renal disease: a case report.

Background: Maturity-onset diabetes of the young (MODY) is a rare monogenic diabetes with significant renal risk, especially when combined with hyperglycemia, obesity, and other factors. While chronic cannabis use may further accelerate kidney decline, no previous reports have described rapid progression to ESRD in a young patient with MODY, obesity, hypertension, and cannabinoid hyperemesis, as presented here. Case presentation: A 24-year-old man with class II obesity, uncontrolled presumed MODY, CKD stage 5, diabetic gastroparesis, hypertension, and chronic marijuana use was diagnosed with MODY at age 18 after hospitalization for cannabinoid hyperemesis and Boerhaave syndrome. Despite insulin and metformin therapy, he experienced recurrent hypertensive crises and AKI with progressive renal decline. Over 70 months, the patient experienced progressive renal and metabolic deterioration. Serum creatinine increased from 0.9 to 10.8 mg/dL (mean 2.92), with eGFR declining from 115.98 to 4.69 mL/min/1.73 m Conclusion: This first reported case of presumed MODY, obesity, hypertension, cannabis use, and poor adherence in a young adult demonstrates unusually rapid progression to end-stage renal disease (ESRD), highlighting the need for early recognition and integrated management in high-risk patients.