Glomerular and tubulointerstitial diseases

This article provides a general overview of some of the more common or illustrative glomerular and tubulointerstitial disorders encountered in clinical practice. Disorders are grouped into those causing the nephrotic syndrome, the acute nephritic syndrome and rapidly progressive glomerulonephritis (RPGN), and chronic tubulointerstitial disease. This division is useful for narrowing the differential diagnosis and deciding on further testing and management. Elements of the past history, including detailed family, medication, and social histories, and recent symptoms and physical examination findings are as much a part of the diagnostic workup as are urinary and blood tests. An assessment of the tempo and severity of renal deterioration is critical to separate potential medical emergencies, such as RPGN, from those more indolent disorders that can be managed by the primary care physician.     

PPARs and heart diseases

After it has been reported that activation of PPARalpha or PPARgamma suppresses production of proinflammatory cytokines, medical interest in PPARs have grown and a huge research effort has been concentrated. Synthetic antidiabetic thiazolidinediones (TZDs) and natural prostaglandin D2 (PGD2) metabolite, 15d-PGJ2, are well known as ligands for PPARgamma. Hyperlipidemic drugs (fibrates) are synthetic PPARalpha ligands. Recent studies suggest that ligands of PPAR not only regulate glucose and lipid metabolism but also have pleiotropic effects on many tissues and cell types. Ligands of PPARs may become therapeutic agents useful in the prevention of cardiovascular diseases beyond their effects on glucose and lipid metabolism. This review will focus on the latest developments in the PPARs field and the roles of PPAR-dependent pathway in cardiovascular diseases.