Iglesias Pedro, Díez Juan J
Department of Endocrinology, Hospital General, Segovia, Spain.
Eur J Endocrinol. 2006 May;154(5):613-21. doi: 10.1530/eje.1.02134.
Type 2 diabetes is a well recognised cause of chronic renal failure (CRF). Only few oral antidiabetic drugs can be used for treating type 2 diabetes in patients with CRF. Among them are repaglinide, a rapid-acting prandial insulin releaser, and peroxisome proliferator-activated receptor gamma (PPARgamma) agonists, such as rosiglitazone and pioglitazone. These compounds are metabolised in the liver, therefore accumulation of the drug and the risk of severe and prolonged hypoglycaemia are minimised. PPARgamma receptors are expressed in many tissues including the kidney. Recently, numerous healthful effects of PPARgamma agonists on several aspects related to renal function have been increasingly reported. These drugs have shown to possess many advantageous anti-inflammatory, haemodynamic, vascular and metabolic effects. In the present paper we have reviewed the more recent experimental studies that evaluated these potential beneficial effects of PPARgamma agonists on renal function and revised the results of their utilisation in patients with different degrees of renal impairment, in dialysis patients, and in patients with diabetes mellitus after kidney transplantation. Finally, tolerability and safety profile of PPARgamma agonists in patients with reduced glomerular filtration rate are also analysed.
2型糖尿病是慢性肾衰竭（CRF）的一个公认病因。仅有少数口服抗糖尿病药物可用于治疗CRF患者的2型糖尿病。其中包括瑞格列奈，一种速效餐时胰岛素促泌剂，以及过氧化物酶体增殖物激活受体γ（PPARγ）激动剂，如罗格列酮和吡格列酮。这些化合物在肝脏中代谢，因此药物蓄积以及严重和长期低血糖的风险降至最低。PPARγ受体在包括肾脏在内的许多组织中表达。最近，越来越多的报道称PPARγ激动剂在与肾功能相关的多个方面具有诸多有益作用。这些药物已显示具有许多有利的抗炎、血流动力学、血管和代谢作用。在本文中，我们回顾了评估PPARγ激动剂对肾功能这些潜在有益作用的最新实验研究，并修订了它们在不同程度肾功能损害患者、透析患者以及肾移植后糖尿病患者中的应用结果。最后，还分析了PPARγ激动剂在肾小球滤过率降低患者中的耐受性和安全性。
