Peroxisome proliferator-activated receptor gamma agonists in kidney disease - future promise, present fears

The peroxisome proliferator-activated receptor superfamily (PPARs) comprises a class of nuclear receptors with significant effects in regulating multiple cellular pathways. Much research and clinical interest has surrounded the PPAR-Y isoform because of its key role in the transcriptional regulation of metabolic pathways and the efficacy of thiazolidinediones, the most clinically used PPAR-Y agonist, in the management of type 2 diabetes mellitus. In this review, we discuss the pathogenic role of PPAR-Y in experimental models of kidney disease, clinical trials of thiazolidinediones in diabetic and non-diabetic kidney disease, recent safety concerns surrounding PPAR-Y agonists and reflect on their potential use in 'orphan' kidney diseases.